Chest
Volume 100, Issue 5, November 1991, Pages 1328-1333
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Clinical Investigations
Ultrasound-Guided Pleural Biopsy with Tru-Cut Needle

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We conducted a study of ultrasound (US)-guided pleural biopsy with a Tru-Cut needle and made a comparison with the results of a traditional pleural biopsy with an Abrams needle. A total of 49 patients with unilateral pleural effusion were included in this study. Twenty-four patients underwent a traditional pleural biopsy with an Abrams needle, and 25 patients underwent a US-guided pleural biopsy with a Tru-Cut needle. The age, sex, and underlying diseases in both groups were compatible. The amount of effusion was much less in the Tru-Cut group. In the patients who underwent the US-guided pleural biopsy with a Tru-Cut needle, the diagnostic sensitivity in pleural tuberculosis was 86 percent (677) and in pleural neoplasia it was 70 percent (7/10). In the patients who underwent traditional pleural biopsy with an Abrams needle, the diagnostic sensitivity in pleural tuberculosis was 20 percent (2/10) and in pleural neoplasia it was 44 percent (4/9). The result of US-guided pleural biopsy with a Tru-Cut needle was better than that of pleural biopsy with an Abrams needle, especially in pleural tuberculosis. No complication was found in the Tru-Cut group, but breakage and dislodgment of the tip of an Abrams needle occurred in one patient. The higher diagnostic yield in the Tru-Cut group may be attributed to the US guidance that can delineate the focal pleural abnormalities for biopsy. In conclusion, US-guided pleural biopsy by using a Tru-Cut needle was simple, safe, and well tolerated. It was particularly useful for patients with pleural tumor, thickened pleura, small amounts of pleural effusion, or loculated pleural effusion.

Section snippets

Patients and Methods

From January 1987 through June 1990, the data on 49 patients in National Taiwan University Hospital who had undergone a pleural biopsy were reviewed to compare the diagnostic efficacy of the traditional Abrams needle and the Tru-Cut needle under US guidance. The following patients were excluded: (1) patients with bilateral pleural effusions; (2) those with transudative effusions; (3) those with effusions that appeared to be grossly purulent; (4) and those who had a hemorrhagic diathesis. There

US-guided Pleural Biopsy with Tru-Cut Needle

Twenty-five patients with a pleural lesion underwent US-guided pleural biopsy using a Tru-Cut needle. Two patients underwent pleural biopsy twice: one patient received the diagnosis of pleural tuberculosis at the second pleural biopsy; in the other patient the diagnosis of neoplastic pleuritis was based on effusion cytologic study, although the two biopsies were inconclusive. The other 23 patients underwent only one pleural biopsy each. Of these 25 patients with pleural effusions there were ten

Discussion

Previous studies have shown that closed pleural biopsy using a Cope or an Abrams needle can be used to diagnose 57 to 80 percent of cases of tuberculous effusion and 40 to 73 percent of cases of neoplasia.3,5,6,19, 20, 21 In this study, the diagnostic sensitivity of the US-guided pleural biopsy with a Tru-Cut needle was 70 percent (7/10) for pleural neoplasia and 86 percent (6/7) for pleural tuberculosis. The diagnostic sensitivity with an Abrams needle was 20 percent (2/10) for pleural

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    Reprint requests: Dr. Chang, National Taiwan University Hospital, No. 1, Chang-Te Street, Taipei, Taiwan, Republic of China

    Manuscript received December 14; revision accepted February 13.

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