title: Combined ultrasound-guided cutting-needle biopsy and standard pleural biopsy for diagnosis of malignant pleural effusions.
abstract: The most efficient approach to diagnose malignant pleural effusions (MPEs) is still controversial and uncertain. This study aimed to evaluate the utility of a combined approach using ultrasound (US)-guided cutting-needle biopsy (CNB) and standard pleural biopsy (SPB) for diagnosing MPE.
  
  
  
  Pleural effusions were collected from 172 patients for biochemical and microbiological analyses. US-guided CNB and SPB were performed in the same operation sequentially to obtain specimens for histological analysis.
  
  
  
  US-guided CNB and SPB procedures provided adequate material for histological analysis in 90.7 and 93.0% of cases, respectively, while a combination of the 2 techniques was in 96.5% of cases. The sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and diagnostic accuracy of US-guided CNB versus SPB were: 51.2 vs 63.4%, 100 vs 100%, 100 vs 100%, 64.9 vs 72.2% and 74.4 vs 81.3%, respectively. When CNB was combined with SPB, the corresponding values were 88.6, 100, 100, 88.6 and 93.9%, respectively. Whereas sensitivity, NPV and diagnostic accuracy were not significantly different between CNB and SPB, the combination of CNB and SPB significantly improved the sensitivity, NPV and diagnostic accuracy versus each technique alone (p < 0.05). Significant pain (eight patients), moderate haemoptysis (two patients) and chest wall haematomas (two patients) were observed following CNB, while syncope (four patients) and a slight pneumothorax (four patients) were observed following SPB.
  
  
  
  Use of a combination of US-guided CNB and SPB afforded a high sensitivity to diagnose MPEs, it is a convenient and safe approach.
authors.affiliation: Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China.
authors.forename: Jinlin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Xinghua
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China.
authors.forename: Panxiao
authors.initials: P
authors.lastname: Shen
authors.affiliation: Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China. yunxiangzeng@126.com.
authors.forename: Yunxiang
authors.initials: Y
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002681:China; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging*; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult
keywords: Cutting-needle biopsy; Pleural biopsy; Pleural effusion; Ultrasound