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CT-scan guided Abrams needle pleural biopsy or medical thoracoscopy: which method in which patient

Background: No consensus exists regarding which biopsy methods are appropriate for specific procedures in pleural diseases. In this ongoing randomized-prospective study, we aim to compare computed tomography scan guided pleural biopsy using an Abrams’ needle (CT-ANPB) with medical thoracoscopy (MT) according to the CT findings of the patients with respect to both diagnostic yield and safety. Methods: A total of 71 patients with exudative pleural effusion who could not be diagnosed by cytological analysis were included. All patients were separated to two groups regarding to the CT findings: Only pleural effusion or pleural effusion with pleural thickening/lesion. In each group, the patients were randomized into either underwent CT-ANPB or either underwent MT. The two groups were compared in terms of diagnostic sensitivity, accuracy and the complications. Results: In only pleural effusion group, 33 patients, CT-ANPB had a diagnostic sensitivity of 63.6%, as compared to 80.0% for MT. Accuracy for both methods are 73.3%, and 90.5%, respectively. Pleural effusion with pleural thickening/lesion group, 38 patients, CT-ANPB had a diagnostic sensitivity of 85.7%, as compared to 100% for MT. Accuracy for both methods are 87.5%, and 100%, respectively. CT-ANPB’s sensitivity was low in only pleural effusion group with respect to others (p=0.044). There was no difference between CT-ANPB and MT in patients who had pleural fluid and pleural thickening/lesion in CT scans. Complication rates were low and acceptable. Conclusion: For patients with only pleural fluid appearance on CT the primary method of diagnosis should be medical thoracoscopy. We will get clearer opinion as the number of patients increases.