Pleural needle biopsy under imaging method in the diagnosis ofpleural diseases: Abrams needle and cutting needle

This study was conducted to determine and compare the diagnostic accuracy, reliability, and safety of the cutting needle and Abrams needle, which are used under imaging guidance to diagnose pleural diseases. Our study included patients with pleural fluid who were consecutively admitted to the clinic between June 31, 2022, and June 14, 2023, who could not be diagnosed with clinical, radiological, laboratory, and cytological examinations, who had an invasive method/biopsy indication, and who underwent pleural biopsy by randomizing them into two arms as cutting needle and Abrams needle in accordance with the consort diagram. It includes the evaluation of 148 patients. After determining the possible entry site with CT according to the randomization arm, the biopsy was performed with a cutting needle or Abrams needle under TUS guidance. The usual practice was used for Abrams needle biopsy, and the free hand technique was used for the cutting needle. According to the randomization arms, the diagnostic accuracy in the cutting needle group was 63,01%, – LR was 0,47, while in the Abrams group, it was 78,67%, 0,30; A statistically significant difference in diagnostic accuracy was detected between the two groups in favor of the Abrams needle (p=0,036). When the diagnostic accuracy was categorized and analyzed according to both CT and TUS findings, there was no significant difference between those with pleural fluid alone and those with pleural thickening/lesion in addition to fluid appearance according to CT findings. On the other hand, when needle success was evaluated as pleural thickening < 1 cm or ≥ 1 cm according to TUS findings, the diagnostic accuracy of the Abrams needle was higher (77,30%) than the cutting needle (55,20%) in those with pleural thickening < 1 cm according to TUS. (p=0,009). Similarly, the diagnostic accuracy in the cutting needle arm increased significantly, from 55,20% to 93,30% in those with pleural thickening ≥ 1 cm (p = 0,006). Additionally, in patients with pleural thickening ≥ 1 cm, the Abrams needle – LR value was 0,17, while this value was 0,08 for the cutting needle. As a result, when pleural thickening in TUS was < 1 cm, the Abrams needle was considered preferable, and when it was ≥ 1 cm, the cutting needle was considered preferable in terms of diagnostic accuracy and reliability.