Image-Assısted Pleural Needle Biopsy or Medical Thoracoscopy: Which Method for Which Patient? A Randomızed Controlled...

Area of Science:

• Pulmonology
• Thoracic Surgery
• Diagnostic Procedures

Background:

• Image-guided and medical thoracoscopy (MT) improve pleural disease diagnosis.
• A consensus is lacking on the optimal initial biopsy method for undiagnosed pleural effusion.

Purpose of the Study:

• To determine the most appropriate biopsy method for maximizing diagnostic accuracy in pleural effusion.
• To compare the diagnostic accuracy and safety of image-assisted Abrams needle pleural biopsy (IA-ANPB) and MT.

Main Methods:

• A prospective, randomized study of 228 patients with undiagnosed exudative pleural effusion.
• Patients were stratified into two groups: effusion only (Group 1) and effusion with thickening/lesions (Group 2).
• Random assignment to IA-ANPB or MT for diagnostic sensitivity, reliability, and safety assessment.

Main Results:

• In Group 1, MT had higher sensitivity (96.9%) and lower false-negative rate (3.1%) than IA-ANPB (69.7% sensitivity, 30.3% false-negative).
• In Group 2, both IA-ANPB (88.1% sensitivity) and MT (95.4% sensitivity) demonstrated comparable diagnostic success.
• No significant difference in complication rates was observed between IA-ANPB and MT.

Conclusions:

• Medical thoracoscopy (MT) is highly successful for diagnosing pleural effusion.
• Image-assisted Abrams needle pleural biopsy (IA-ANPB) offers similar diagnostic success to MT in cases with associated pleural thickening or lesions.
• IA-ANPB may be a preferable initial option for patients with pleural effusion and associated thickening or lesions.