Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies

Pleural biopsies are often necessary if a pleural effusion remains undiagnosed after radiological imaging and pleural fluid analysis. There are many methods of obtaining pleural biopsies, including blind or image-guided procedures, closed-bevel or cutting-edge needles, and percutaneous or thoracoscopic approaches. This article will review recent research relating to these methods, aiming to provide an overview of the strengths and limitations of each technique.

Historically pleural biopsies were undertaken using a blind closed 'Abrams' needle method. However, low diagnostic yields and high complication rates are seen with this technique compared with newer methods. Recent research compares image-guided, cutting-needle approaches to traditional Abrams biopsies, and evaluates the role of medical thoracoscopy in comparison to other techniques.

Thoracoscopic biopsies are the gold standard for investigating pleural disease. However, this service is not universally available and may be unsuitable for some patients. Image-guided cutting-needle biopsies under computed tomography or ultrasound guidance have high diagnostic rates and are useful in a wide patient population. The main role of Abrams biopsies is in the diagnosis of tuberculous pleuritis in resource-poor settings.