CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial

Abstract

Background: Image-guided pleural biopsies, both using ultrasound (US) or computed tomography (CT), are important in the diagnosis of pleural disease. However, no consensus exists regarding which biopsy needles are appropriate for specific procedures. Objectives: In this randomized, prospective study, we aimed to compare CT scan-guided pleural biopsy using an Abrams' needle (CT-ANPB) with US-assisted pleural biopsy using a cutting needle (US-CNPB) with respect to both diagnostic yield and safety. Methods: Between February 2009 and April 2013, 150 patients with exudative pleural effusion who could not be diagnosed by cytological analysis were included in the study. The patients were randomized into either the US-CNPB group or the CT-ANPB group. The two groups were compared in terms of diagnostic sensitivity and complications. Results: Of the 150 patients enrolled in this study, 45 were diagnosed with malignant mesothelioma, 46 were diagnosed with metastatic pleural disease, 18 were diagnosed with pleural tuberculosis, 34 were diagnosed with benign pleural disease, and 7 were lost to follow-up. In the US-CNPB group, the diagnostic sensitivity was 66.7%, compared with 82.4% in the CT-ANPB group; the difference between the two groups was statistically significant (p = 0.029). The sensitivity of CT-ANPB increased to 93.7% for patients with a pleural thickness ≥1 cm. The complication rates were low and acceptable. Conclusions: The first diagnostic intervention that should be preferred in patients with pleural effusion and associated pleural thickening on a CT scan is CT-ANPB. US-CNPB should be used primarily in cases for which only pleural thickening but no pleural effusion is noted.

Image Guidance of Pleural Biopsies: Are Electromagnetic Waves Superior to Sound Waves?

“…The present study by Metintas and colleagues [9] once again validates the use of CT-guided Abrams needle biopsy as an alternative to thoracoscopy, particularly in patients with pleural thickening. However, only a randomised study comparing CT-guided and ultrasound-guided biopsy, where only Abrams needles are used, would establish whether CT guidance is truly superior to ultrasound guidance as the imaging modality of choice.…”

“…In the present issue of Respiration , Metintas and co-workers [9] report the first randomised prospective study comparing CT-scan-guided pleural biopsy using an Abrams needle with ultrasound-assisted pleural biopsy with a cutting needle with respect to both diagnostic yield and safety. The authors report that CT-guided biopsy has a superior yield (82.4 vs. 66.7%, p = 0.029).…”

“…Before mothballing one's ultrasound machine, there are a few important considerations. Most notably, Metintas et al [9] compared not only two different imaging modalities, but also the performance of two very different biopsy needle types. In the context of ultrasound-assisted biopsy, Abrams needle biopsy specimens have already been shown to yield more pleural tissue than those obtained using Tru-Cut needles (91.0 vs. 78.7%, p = 0.015) [5].…”

Novel systemic therapy against malignant pleural mesothelioma

“…The diagnosis of MPM requires adequate tissue in the context of appropriate clinical, radiographic, and surgical findings. Thoracoscopic biopsy is considered the gold standard diagnostic method and case series have reported diagnostic sensitivity to range from 94-98% (19)(20)(21). CT-guided needle biopsy is also commonly used and has a reported sensitivity of 83-88% (22)(23)(24)(25)(26).…”

Imaging of malignant pleural mesothelioma: it is possible a screening or early diagnosis program?—a systematic review about the use of screening programs in a population of asbestos exposed workers

“…The sensibility of trans-parietal biopsy is between 50% and 85% (19), lower than thoracoscopy; for this reason, it is therefore not routinely recommended for definitive diagnosis of mesothelioma, except in patients non-suitable to thoracoscopy. Indeed, when MPM is suspected by clinical or radiological data the diagnostic accuracy of thoracoscopy is very high, exceeding 90%, and complications occur in less than 10% of cases (14,15,20).…”