title: Thoracic ultrasound-assisted selection for pleural biopsy with Abrams needle.
abstract: BACKGROUND
  Closed pleural biopsy (CPB) in patients with malignant pleural effusion is less sensitive than cytology. Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where secondary spread from pleural metastases is initially more likely to be found. We analyzed whether choosing the point of entry for CPB with thoracic ultrasound assistance influences the diagnostic yield in malignant pleural effusion.
  
  
  METHODS
  This prospective study included patients who underwent CPB performed by an experienced pulmonologist in 2008-2010 (group A) and thoracic ultrasound was used to select the biopsy site. The results were compared with a historical series of CPB performed by the same pulmonologist without the assistance of thoracic ultrasound (group B). An Abrams needle was used in all cases. We analyzed the obtaining of pleural tissue and the diagnostic yield.
  
  
  RESULTS
  We included 114 CPBs from group A (23% tuberculous pleural effusion, 27% malignant pleural effusion) and 67 CPBs from group B (24% tuberculous pleural effusion, 30% malignant pleural effusion) (P = .70). Pleural tissue was obtained in 96.5% of the group A CPBs and 89.6% of the group B CPBs (P = .05). The diagnostic yields of CPB for tuberculous pleural effusion and malignant pleural effusion in group A were 89.5% and 77.4%, respectively, and 91.7% and 60%, respectively, in group B (P = .80 for tuberculous pleural effusion, and P = .18 for malignant pleural effusion).
  
  
  CONCLUSIONS
  Selecting the point of entry for CPB using thoracic ultrasound increases the likelihood of obtaining pleural tissue and the diagnostic yield, but without statistical significance. We recommend ultrasound-assisted CPB to investigate pleural effusion, since the diagnostic yield of a pleural biopsy with an Abrams needle increased by > 17% in subjects with malignant pleural effusion.
authors: Bronchopleural Unit, Department of Pneumology.
authors: Maribel
authors: M
authors: Botana-Rial
authors: Virginia
authors: V
authors: Leiro-Fernández
authors: Cristina
authors: C
authors: Represas-Represas
authors: Ana
authors: A
authors: González-Piñeiro
authors: Amara
authors: A
authors: Tilve-Gómez
authors: Alberto
authors: A
authors: Fernández-Villar
mesh_terms: D044963:Biopsy, Fine-Needle / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009339:Needles; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D013909:Thorax / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Abrams pleural needle; biopsy pleural; diagnostic; malignant pleural effusion; thoracic ultrasound