الفهرس 
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Abstract
This study was conducted out on 40 patients with unexplained exudative lymphocytic pleural effusion. It was carried out in Chest Department, Faculty of Medicine, Tanta University Hospitals during the period from December 2022 to October 2023. • The patients included in this study were divided into 2 groups: • 1st group 20 patients for Ultra-sound Guided Tru-cut Needle pleural Biopsy. • 2nd group 20 patients for Medical Thoracoscopy. The aim of this study was to evaluate the effectiveness of Ultra-Sound Guided Tru-Cut Needle Pleural Biopsy (Safety, Accuracy, Time and Cost of The procedure) in diagnosis of UELPE compared to medical thoracoscopy. • All Patients will be subjected to: 1) Thorough history taking and complete physical examination. 2) Complete blood picture, C reactive protein, Liver function tests, blood urea and serum creatinine, ESR and Blood sugar (fasting and 2 hrs. post prandial). 3) preprocedural evaluation; Measurement of O2 saturation, ABG, ECG, bleeding profile, stop anticoagulant before procedure. 4) imaging. a. Chest X-ray (PA & lateral views) before and after the procedure. b. CT Chest. c. Chest ultra-sound for all patients using high resolution realtime ultra- sound. 5) Histopathological examination of biopsy samples. 6) Full clinical, medical care and radiological follow- up after USGNB and MT regarding wound and chest tube to detect any complications. In group I the mean value of age and sex was 52.95 ±14.1 years, 14 (70%) patients were males and 6 (30%) patients were females, while in group II the mean value of age was 54.25 ± 13.59 years, 15 (75%) patients were males, and 5 (25%) patients were females without significant statistical difference between the two studied groups. The clinical presentation: dyspnea was the most common, found in 16 patients (80%) In group I and 18 patients (90%) In group II, Followed by chest pain, cough and fever there was no significant statistical difference between the two studied groups regarding clinical presentations. Gross finding seen during the procedure (More than one pathology could be found in any patient); pleural nodules were the most found pleural pathology then pleural thickening, adhesions and masses. Some patients had pleural effusion without any pleural pathology. In this study, complications that occurred were in the form of pain at the site of biopsy which was present in 3 patients (15%) in group I and 12 patients (60%) in group II, Failure of the lung to expand and Surgical emphysema were not detected in any patient in group I while in group II, 5 patients (25%) were detected, the previous three were significantly higher in group II compared to group I. Hemoptysis, Pneumothorax, bleeding at site of insertion, fever, secondary infection to pleural fluid and Wound infection had no significant statistical difference between the two studied groups. The mean value of length of hospital stay was 2.0±1.69 and 12.50±9.43 day in group I and group II respectively. It was significantly short in group I compared to group. The final histopathological diagnosis in group I was; pleural fibroma in 1 patients (5%), inflammatory lung lesion was not detected in any patient (0%), malignant mesothelioma in 5 patients (25 %), metastatic adenocarcinoma in 7 patient (35%) of patients and pleural TB was found in 3 patient (15%). There were 4 (20%) of patients with undiagnosed pleural lesions. In group II the final histopathological diagnosis was inflammatory lung lesion was found in 3 patients (15%), pleural fibroma lesion was not detected in any patient (0%), malignant mesothelioma in 3 patients (15%), metastatic adenocarcinoma in 8 patients (40%) of patients and pleural TB was found in 5 patients (25 %). There were 1 (5%) of patients with undiagnosed pleural lesions. There was no significant statistical difference between the two studied groups regarding histopathological finding. In our study, diagnostic yield for sonar-guided biopsy in UEPE was 80% (16 0f 20 patients) versus diagnostic yield of thoracoscopic guided biopsy was 95% (19 0f 20 patients) with no significant statistical difference between both groups. The 4 patients not diagnosed by USGPB; 2 of them were diagnosed as metastatic adenocarcinoma by MT, one patient not diagnosed one time MT and the patient refused more follow-up and the last one was generally unfit for MT. The conclusion of our study is that; UGNPB is accurate as, faster, safer with lower cost and complications than MT in diagnosis of UEPE. We had limitation of small number of patients involved in our study and our study was carried out in single center. We recommend more studies to support our results, early use of US in diagnosis of UEPE and pulmonologist using it must be well-trained.