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Randomized Controlled Trial
. 2025 Jul 1;42(4):321-328.
doi: 10.4274/balkanmedj.galenos.2025.2025-4-90.

Ultrasound-Guided Pleural Needle Biopsy Which Needle for Which Patient: A Prospective Randomized Study

Emre Çelik  1 , Muzaffer Metintaş  1   2 , Güntülü Ak  1   2 , Hüseyin Yıldırım  1 , Emine Dündar  3 , Nevin Aydın  4 , Selma Metintaş  2   5
Affiliations
Randomized Controlled Trial

Ultrasound-Guided Pleural Needle Biopsy Which Needle for Which Patient: A Prospective Randomized Study

Emre Çelik et al. Balkan Med J. .

Abstract

Background: Given the growing incidence of pleural effusions and the limited availability of medical thoracoscopy (MT) in clinical practice, ultrasound (US)-guided pleural needle biopsies using Abrams or cutting needles are increasingly being used for the histopathological diagnosis of pleural diseases.

Aims: To assessed the diagnostic yield and safety of US-guided Abrams and cutting needles to determine the optimal needle type for specific clinical situations.

Study design: Prospective randomized study.

Methods: The study included 174 patients with undiagnosed pleural effusion requiring histopathological evaluation. Patients were randomized into two arms: those who underwent US-guided cutting needle biopsy (US-CNPB) and those who underwent US-guided Abrams needle biopsy (US-ANPB).

Results: The US-CNPB group exhibited a false-negative rate of 36.9% and diagnostic accuracy of 63.0%. compared to 21.3% and 78.7% in the US-ANPB group, with significant differences between the groups (p = 0.036 and 0.045, respectively). In patients with pleural thickening < 1 cm or absent on US, US-CNPB exhibited 55.2% diagnostic accuracy and a negative likelihood ratio (-LR) of 0.57. For US-ANPB, the corresponding rates were 77.3% and 0.32. The difference in diagnostic accuracy between the two groups was significant (p = 0.009). In patients with pleural thickening ≥ 1 cm, the diagnostic accuracy of US-CNPB was 93.3% and 88.9% for US-ANPB, with no significant difference between the groups. The corresponding -LR values were 0.08 and 0.17. In patients with pleural thickening < 1 cm, four major bleeding events (6.9%) occurred in the US-CNPB group. No deaths were reported in this study.

Conclusion: US-CNPB should be preferred in patients with pleural thickness ≥ 1 cm on US. MT is recommended for patients with pleural thickening < 1 cm or those presenting with pleural effusion without pleural thickening. However, in the absence of MT, US-ANPB is the preferred alternative because of its superior diagnostic accuracy and procedural safety.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
The comparison of the diagnostic accuracy of the biopsy needles.
See this image and copyright information in PMC

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