Rationale: The diagnostic yields of traditional ultrasound-guided pleural biopsy remain unsatisfactory, especially when the pleural thickness is ? 5 mm and/or no pleural nodules are detected. Pleural ultrasound elastography has a better diagnostic yield than traditional ultrasound for malignant pleural effusion. However, studies of ultrasound elastography-guided pleural biopsy are lacking.

Objectives: To evaluate the feasibility and safety of ultrasound elastography -guided pleural biopsies.

Methods: In this multicenter prospective observational study, patients with pleural effusion whose pleural thickness ? 5 mm and no pleural nodules were enrolledbetween July 2019 and August 2021. Ultrasound elastography-guided pleural biopsy diagnostic yield for pleural effusion and sensitivity for malignant pleural effusion were evaluated.

Measurements and Main Results: Ninety-eight patients (mean age, 62.4±13.2 years; 65 men) were prospectively enrolled. The diagnostic yield of ultrasound elastography-guided pleural biopsy was 92.9% (91/98), and the sensitivity of ultrasound elastography-guided pleural biopsy for malignant pleural effusion was 88.7% (55/62). In additional, the sensitivity of ultrasound elastography-guided pleural biopsy for pleural tuberculosis was 69.6% (16/23). The rate of postoperative chest pain was acceptable, and there was no pneumothorax in patients.

Conclusions: Elastography-guided pleural biopsy is a novel technique for diagnosing malignant pleural effusion with a good diagnostic yield and sensitivity.