Ultrasound-Guided Pleural Needle Biopsy Which Needle for Which Patient: A Prospective Randomized Study

Area of Science:

• Pulmonology
• Interventional Radiology
• Diagnostic Pathology

Background:

• Increasing incidence of pleural effusions necessitates effective diagnostic methods.
• Limited availability of medical thoracoscopy (MT) drives the adoption of ultrasound (US)-guided pleural needle biopsies.
• US-guided biopsies using Abrams or cutting needles are crucial for histopathological diagnosis of pleural diseases.

Purpose of the Study:

• To evaluate the diagnostic yield and safety of US-guided Abrams and cutting needles.
• To determine the optimal needle type for specific clinical scenarios in diagnosing pleural effusions.
• To compare the efficacy of US-guided cutting needle biopsy (US-CNPB) versus US-guided Abrams needle biopsy (US-ANPB).

Main Methods:

• A prospective randomized study involving 174 patients with undiagnosed pleural effusion.
• Patients were randomized into two groups: US-guided cutting needle biopsy (US-CNPB) and US-guided Abrams needle biopsy (US-ANPB).
• Diagnostic yield, accuracy, and safety (including complication rates) were assessed for both needle types.

Main Results:

• US-ANPB demonstrated significantly higher diagnostic accuracy (78.7%) and lower false-negative rates (21.3%) compared to US-CNPB (63.0% accuracy, 36.9% false-negative).
• For pleural thickening < 1 cm, US-ANPB showed superior diagnostic accuracy (77.3%) and safety (no major bleeding) versus US-CNPB (55.2% accuracy, 6.9% bleeding events).
• For pleural thickening ≥ 1 cm, both methods achieved high diagnostic accuracy (US-CNPB: 93.3%, US-ANPB: 88.9%) with no significant difference.

Conclusions:

• US-CNPB is preferred for pleural effusions with thickening ≥ 1 cm.
• Medical thoracoscopy (MT) is recommended for effusions with thickening < 1 cm or without visible thickening.
• In the absence of MT, US-ANPB is the preferred alternative due to its higher diagnostic accuracy and safety profile for pleural effusion diagnosis.