Medical Thoracoscopy vs CT Scan-Guided Abrams Pleural Needle Biopsy for Diagnosis of Patients With Pleural Effusions

Metintaş, Muzaffer; Ak, Güntülü; Dündar, Emine; Yıldırım, Hüseyin; Özkan, Ragıp; Kurt, Emel; Erginel, Sinan; Alataş, Füsun; Metintaş, Selma

doi:10.1378/chest.09-0884

Cited by 160 publications

(133 citation statements)

References 22 publications

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“…4 Metintas et al found no significant differences in the sensitivities of medical thoracoscopy and CT-guided Abrams pleural needle biopsy in subjects with malignant pleural effusion. 6 The diagnostic sensitivities were 94% and 87%, respectively. However, the majority of those studies included subjects with pleural effusion and pleural thickening due to malignant mesothelioma.…”

Section: Discussionmentioning

confidence: 97%

“…Image-guided pleural biopsy provides the highest diagnostic accuracy. [6][7][8][9] Image-guided pleural biopsy with a Tru-Cut needle provides the highest sensitivity: 70% with ultrasound, 87% with CT. 8,9 Especially in the presence of pleural masses, thickening or nodularity, CPB should be CT or ultrasound guided, and with a Tru-Cut needle. The Abrams needle is indicated in pleural effusion without pleural thickening or nodularity.…”

Section: Discussionmentioning

confidence: 99%

“…However, the majority of those studies included subjects with pleural effusion and pleural thickening due to malignant mesothelioma. [6][7][8]10 Image-guided CPB is the technique of choice, with a high diagnostic yield, in patients with masses or diffuse, nodular pleural thickening. 4,6,8,9,16 Mesothelioma is the malignant pleural effusion included most frequently in CPB studies, but this does not reflect the patient population in the present study in our institution.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8]10 Image-guided CPB is the technique of choice, with a high diagnostic yield, in patients with masses or diffuse, nodular pleural thickening. 4,6,8,9,16 Mesothelioma is the malignant pleural effusion included most frequently in CPB studies, but this does not reflect the patient population in the present study in our institution. [6][7][8]10 The incidence of mesothelioma in our study was low, and image-guided pleural biopsy has the highest diagnostic accuracy for mesothelioma.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Nevertheless, some studies have proposed that CPB guided by imaging can obtain a diagnostic yield similar to that of thoracoscopy. [6][7][8][9][10] Pleural biopsy guided by imaging (computed tomography [CT] or ultrasound scan) or thoracoscopy should be performed in almost all patients with exudative pleural effusion of unknown etiology. 2,11 Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where the secondary spread from pleural metastases is more likely to be initially found, and may lead to improved diagnostic yield.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic Ultrasound-Assisted Selection for Pleural Biopsy With Abrams Needle

Botana-Rial¹,

Leiro-Fernández²,

Represas-Represas³

et al. 2013

Respir Care

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BACKGROUND: Closed pleural biopsy (CPB) in patients with malignant pleural effusion is less sensitive than cytology. Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where secondary spread from pleural metastases is initially more likely to be found. We analyzed whether choosing the point of entry for CPB with thoracic ultrasound assistance influences the diagnostic yield in malignant pleural effusion. METHODS: This prospective study included patients who underwent CPB performed by an experienced pulmonologist in 2008 -2010 (group A) and thoracic ultrasound was used to select the biopsy site. The results were compared with a historical series of CPB performed by the same pulmonologist without the assistance of thoracic ultrasound (group B). An Abrams needle was used in all cases. We analyzed the obtaining of pleural tissue and the diagnostic yield. RESULTS: We included 114 CPBs from group A (23% tuberculous pleural effusion, 27% malignant pleural effusion) and 67 CPBs from group B (24% tuberculous pleural effusion, 30% malignant pleural effusion) (P ‫؍‬ .70). Pleural tissue was obtained in 96.5% of the group A CPBs and 89.6% of the group B CPBs (P ‫؍‬ .05). The diagnostic yields of CPB for tuberculous pleural effusion and malignant pleural effusion in group A were 89.5% and 77.4%, respectively, and 91.7% and 60%, respectively, in group B (P ‫؍‬ .80 for tuberculous pleural effusion, and P ‫؍‬ .18 for malignant pleural effusion). CONCLUSIONS: Selecting the point of entry for CPB using thoracic ultrasound increases the likelihood of obtaining pleural tissue and the diagnostic yield, but without statistical significance. We recommend ultrasound-assisted CPB to investigate pleural effusion, since the diagnostic yield of a pleural biopsy with an Abrams needle increased by > 17% in subjects with malignant pleural effusion.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Thoracic Ultrasound-Assisted Selection for Pleural Biopsy With Abrams Needle

Botana-Rial¹,

Leiro-Fernández²,

Represas-Represas³

et al. 2013

Respir Care

View full text Add to dashboard Cite

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Mesothelioma

Nowak

Edwards

Creaney

2017

Textbook of Uncommon Cancer

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Cytologic Differential Diagnosis of Malignant Mesothelioma and Reactive Mesothelial Cells With FISH Analysis of p16

Hiroshima

Hasegawa

et al. 2016

Diagnostic Cytopathology

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We confirmed that the p16 FISH results obtained from the cell blocks are as reliable as those from the tissue sections. Cell block analysis is recommended for patients with serosal effusions of unknown origins with the following methods: immunohistochemistry should be performed to validate the mesothelial origin, and p16 FISH should be performed to confirm malignancy. Diagn. Cytopathol. 2016;44:591-598. © 2016 Wiley Periodicals, Inc.

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Medical Thoracoscopy vs CT Scan-Guided Abrams Pleural Needle Biopsy for Diagnosis of Patients With Pleural Effusions

Cited by 160 publications

References 22 publications

Thoracic Ultrasound-Assisted Selection for Pleural Biopsy With Abrams Needle

Thoracic Ultrasound-Assisted Selection for Pleural Biopsy With Abrams Needle

Mesothelioma

Cytologic Differential Diagnosis of Malignant Mesothelioma and Reactive Mesothelial Cells With FISH Analysis of p16

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