Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial

Our plain-English summary of Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial, by M. Metintas, G. Ak, E. Dundar, et al (Chest, 2010).

The study

• Authors: M. Metintas, G. Ak, E. Dundar, H. Yildirim, R. Ozkan, E. Kurt, S. Erginel, F. Alatas, S. Metintas
• Journal: Chest
• Published: 2010;137(6):1362-8
• Type of article: Randomized trial
• Cited by: 118 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: In cases of pleural effusion, tissue samples can be obtained through Abrams needle pleural biopsy (ANPB), thoracoscopy, or cutting-needle pleural biopsy under the guidance of CT scan (CT-CNPB) for histopathologic analysis. This study aimed to compare the diagnostic efficiency and reliability of ANPB under CT scan guidance (CT-ANPB) with that of medical thoracoscopy in patients with pleural effusion.

Methods: Between January 2006 and January 2008, 124 patients with exudative pleural effusion that could not be diagnosed by cytologic analysis were included in the study. All patients were randomized after the CT scan was performed. Patients either underwent CT-ANPB or thoracoscopy. The two groups were compared in terms of diagnostic sensitivity and complications associated with the methods used.

Results: Of the 124 patients, malignant mesothelioma was diagnosed in 33, metastatic pleural disease in 47, benign pleural disease in 42, and two were of indeterminate origin. In the CT-ANPB group, the diagnostic sensitivity was 87.5%, as compared with 94.1% in the thoracoscopy group; the difference was not statistically significant (P = .252). No difference was identified between the sensitivities of the two methods based on the cause, the CT scan findings, and the degree of pleural thickening. Complication rates were low and acceptable.

Conclusion: We recommend the use of CT-ANPB as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan. In patients with only pleural fluid appearance on CT scan and in those who may have benign pleural pathologies other than TB, the primary method of diagnosis should be medical thoracoscopy.

Trial Registration: clinicaltrials.gov; Identifier: NCT00720954.

In plain English

This randomized controlled trial, run at Eskisehir Osmangazi University in Turkey from January 2006 to January 2008, compared two ways of sampling pleural tissue in 124 adults whose exudative pleural effusion could not be diagnosed by cytology. Sixty-two had an Abrams needle biopsy with the entry site chosen from a CT scan (CT-ANPB); 62 had medical thoracoscopy. The article did not report patients' asbestos exposure. Final diagnoses included malignant mesothelioma in 33 patients and benign asbestos pleurisy in 13. Sensitivity, calculated only for malignant and tuberculous cases, was 87.5% (42/48) for CT-ANPB and 94.1% (48/51) for thoracoscopy, a difference that was not statistically significant. For malignant mesothelioma, CT-ANPB diagnosed 12 of 15 patients (80%) and thoracoscopy 17 of 18 (94%), also not significant. One CT-ANPB patient bled enough to need a chest tube and transfusion. The authors recommended CT-ANPB first when CT shows pleural thickening or lesions, and thoracoscopy first when CT shows only fluid or benign asbestos pleurisy or another non-TB benign disease is suspected.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective randomized controlled trial comparing two diagnostic procedures
• Who was studied: 124 patients (72 men, 52 women) with exudative pleural effusion not diagnosed by cytology. They were treated in the Chest Diseases Department, Eskisehir Osmangazi University Medical Faculty, Turkey, January 2006 to January 2008. There were 62 patients in each arm.
• Exposure: The study compared diagnostic procedures, not asbestos exposure. The two procedures were Abrams needle pleural biopsy with the entry site marked from a prior CT scan (CT-ANPB) and medical thoracoscopy. The article does not report fiber types or occupational asbestos exposure.
• Main results:
  • Among all 124 patients, 33 were diagnosed with malignant mesothelioma and 13 with benign asbestos pleurisy. The other diagnoses were lung cancer effusion (29), other organ carcinomas (18), tuberculous pleurisy (19) and others.
  • Patients with benign asbestos pleurisy and several other benign diagnoses were not included in the sensitivity evaluation.
  • In the CT-ANPB group, diagnostic sensitivity for malignant or tuberculous effusion was 87.5% (42 of 48 patients).
  • In the thoracoscopy group, diagnostic sensitivity for malignant or tuberculous effusion was 94.1% (48 of 51 patients). The difference from CT-ANPB was not statistically significant (P = .252).
  • For all malignant cases, sensitivity was 86.8% (33/38; 95% CI, 76.1%-97.5%) for the Abrams needle arm and 95.2% (40/42; 95% CI, 88.7%-100%) for thoracoscopy. The difference was not statistically significant (P = .184).
  • For malignant mesothelioma, CT-ANPB diagnosed 12 of 15 patients (80%) and thoracoscopy 17 of 18 (94%). The authors described the difference as small and not significant (Table 2 P value .308).
  • In patients with pleural thickening under 1 cm, CT-ANPB diagnosed 22 of 27 (82%) and thoracoscopy 25 of 27 (93%). There was no statistical difference.
  • In the CT-ANPB group, one patient with fluid only had a hemorrhage needing tube thoracostomy and blood transfusion. One CT-ANPB patient had a pneumothorax.
  • Percutaneous emphysema at the entry site occurred in 10 of 62 thoracoscopy patients and in none of the 62 Abrams needle patients.
• The authors' conclusion: The authors suggested using CT-ANPB as the first diagnostic step after fluid cytology when CT shows pleural thickening or a pleural lesion. They suggested thoracoscopy first when CT shows only fluid, or when benign asbestos pleurisy or another benign disease other than TB is suspected.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, CT Scan, Needle Biopsy, Pleural Effusion, Pleural Biopsy, Thoracoscopy, Malignant Mesothelioma, Pleural Thickening.

Related studies

• CT-guided core-needle biopsy in omental pathology — F. Pombo, E. Rodriguez, et al. (1997)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Investigation of pleural effusion: comparison between fibreoptic thoracoscopy, needle biopsy and cytology — W.M. Edmondstone (1990)

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