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

IF 1.9 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Balkan Medical Journal Pub Date : 2025-07-01 DOI:10.4274/balkanmedj.galenos.2025.2025-4-90

Emre Çelik, Muzaffer Metintaş, Güntülü Ak, Hüseyin Yıldırım, Emine Dündar, Nevin Aydın, Selma Metintaş

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引用次数: 0

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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超声引导胸膜穿刺活检：一项前瞻性随机研究。

背景：由于胸腔积液的发病率不断上升，而临床胸腔镜（MT）的可用性有限，超声（US）引导下使用Abrams或切割针进行胸膜穿刺活检越来越多地用于胸膜疾病的组织病理学诊断。目的：评估美国引导的艾布拉姆斯针和切割针的诊断率和安全性，以确定适合具体临床情况的最佳针型。研究设计：前瞻性随机研究。方法：本研究纳入174例需要组织病理学评估的未确诊胸腔积液患者。患者被随机分为两组：一组接受美国引导切割针活检（US-CNPB），另一组接受美国引导艾布拉姆斯针活检（US-ANPB）。结果：US-CNPB组假阴性率为36.9%，诊断准确率为63.0%。而US-ANPB组为21.3%和78.7%，组间差异有统计学意义（p分别为0.036和0.045）。对于胸膜增厚< 1 cm或未见US的患者，US- cnpb的诊断准确率为55.2%，负似然比（-LR）为0.57。US-ANPB阳性率分别为77.3%和0.32。两组诊断准确率差异有统计学意义（p = 0.009）。在胸膜增厚≥1 cm的患者中，US-CNPB的诊断准确率为93.3%，US-ANPB的诊断准确率为88.9%，两组间差异无统计学意义。相应的-LR值分别为0.08和0.17。在胸膜增厚< 1 cm的患者中，US-CNPB组发生了4次主要出血事件（6.9%）。本研究无死亡报告。结论：胸膜厚度≥1cm的患者应首选US- cnpb。建议胸膜增厚< 1cm或有胸腔积液而无胸膜增厚的患者行MT。然而，在没有MT的情况下，US-ANPB因其优越的诊断准确性和手术安全性而成为首选选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Balkan Medical Journal MEDICINE, GENERAL & INTERNAL-

CiteScore

4.10

自引率

6.70%

发文量

审稿时长

6-12 weeks

期刊介绍： The Balkan Medical Journal (Balkan Med J) is a peer-reviewed open-access international journal that publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports and clinical images, invited reviews, editorials, letters, comments and letters to the Editor including reports on publication and research ethics. The journal is the official scientific publication of the Trakya University Faculty of Medicine, Edirne, Turkey and is printed six times a year, in January, March, May, July, September and November. The language of the journal is English. The journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. Balkan Medical Journal does not accept multiple submission and duplicate submission even though the previous one was published in a different language. The authors are responsible for the scientific content of the material to be published. The Balkan Medical Journal reserves the right to request any research materials on which the paper is based. The Balkan Medical Journal encourages and enables academicians, researchers, specialists and primary care physicians of Balkan countries to publish their valuable research in all branches of medicine. The primary aim of the journal is to publish original articles with high scientific and ethical quality and serve as a good example of medical publications in the Balkans as well as in the World.