title: Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis.
abstract: BACKGROUND
  Tuberculous pleuritis remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological and/or microbiological confirmation on pleural tissue is the gold standard for its diagnosis. Uncertainty remains regarding the choice of closed pleural biopsy needles.
  
  
  OBJECTIVE
  This prospective study compared ultrasound-assisted Abrams and Tru-Cut needle biopsies with regard to their diagnostic yield for pleural tuberculosis.
  
  
  METHODS
  89 patients (54 men) of mean ± SD age 38.7 ± 16.7 years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo ≥ 4 Abrams needle biopsies followed by ≥ 4 Tru-Cut needle biopsies or vice versa. Medical thoracoscopy was performed on cases with non-diagnostic closed biopsies. Histological and/or microbiological proof of tuberculosis on any pleural specimen was considered the gold standard for pleural tuberculosis.
  
  
  RESULTS
  Pleural tuberculosis was diagnosed in 66 patients, alternative diagnoses were established in 20 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 81 patients (91.0%) and were diagnostic for tuberculosis in 54 patients (sensitivity 81.8%), whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 70 patients (78.7%, p=0.015) and were diagnostic in 43 patients (sensitivity 65.2%, p=0.022).
  
  
  CONCLUSIONS
  Ultrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleura and have a significantly higher diagnostic sensitivity for pleural tuberculosis.
authors.affiliation: Division of Pulmonology, Department of Medicine, University of Stellenbosch, Cape Town, South Africa. coeniefn@sun.ac.za
authors.forename: Coenraad Frederik N
authors.initials: CF
authors.lastname: Koegelenberg
authors.forename: Christoph Thomas
authors.initials: CT
authors.lastname: Bolliger
authors.forename: Johan
authors.initials: J
authors.lastname: Theron
authors.forename: Gerhard
authors.initials: G
authors.lastname: Walzl
authors.forename: Colleen Anne
authors.initials: CA
authors.lastname: Wright
authors.forename: Mercia
authors.initials: M
authors.lastname: Louw
authors.forename: Andreas Henri
authors.initials: AH
authors.lastname: Diacon
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology*; D010996:Pleural Effusion / Q000382:microbiology; D014396:Tuberculosis, Pleural / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult