Comparison of the Raja and the Abrams pleural biopsy needles in patients with pleural effusion

In 31 patients with exudative pleural effusions, we compared the diagnostic yield of the Abrams pleural biopsy needle with that of a new instrument, the Raja pleural biopsy needle. Each patient was randomly biopsied with both needles, and a total of 153 pleural biopsies were done, 73 with the Abrams needle and 80 with the Raja needle. No complications resulted from biopsies with either needle. Etiologic diagnoses were possible in 38 (52%) biopsies obtained using the Abrams needle, compared with 66 (82.5%) for those using the Raja needle; the difference in proportions for the diagnostic yield was statistically significant (p < 0.01, two-tailed Fisher's exact test). There were no significant differences between the needles in obtaining etiologic diagnoses in any specific disease category. The difference between the mean size of the pleural specimens obtained with the two needles was also statistically significant (p < 0.001, Mann-Whitney U test). The Raja pleural biopsy needle is easy and safe to use, and despite its smaller external diameter yields a significantly larger pleural tissue sample and significantly increases the diagnostic yield of pleural biopsies compared with the Abrams pleural biopsy needle.