Introduction and Objectives Last year we presented data highlighting the on-going role for Abrams pleural biopsy in areas with high tuberculosis incidence (1). Feedback reiterated on-going need, but highlighted concerns regarding the attainment of trainee competence at this infrequently performed procedure. We organised and evaluated a half day training course using a well validated porcine-resin model at a regional registrar training day (2).
Methods All attendees (18) underwent a practical training session on pleural biopsy using Abrams and Tru-Cut biopsy needles. Feedback forms were completed and perceived success documented, all samples obtained underwent histological assessment by a specialist respiratory Consultant Histopathologist.
Results Previous experience was limited (median 0.5 prior biopsies performed, range 0–50). On Likert scales (range 1–5) mean confidence improved (1.86, SD 1.21 to 3.83, SD 0.51; p < 0.0001) and the session was deemed useful (mean score 4.5, SD 0.4) with 13/14 (92.9%) trainees who answered stating the session would change their practice. A mean of 4.56 samples (SD 1.42) were obtained per trainee. Sixty-nine of seventy-six samples (90.8%) were perceived to have been successful by the operator, microscopic evidence of mesothelial lined pleura was obtained in nine samples (11.8%) with connective tissue suggestive of possible pleura obtained in a further 25 (33%) (κ = 0.013; poor correlation); real time observation by a training partner suggested a 91.9% success rate (κ = 0.584; moderate correlation). There was no increase in accuracy with increased sampling. Despite encouragement only four participants attempted the Tru-Cut method.
Conclusions The session was popular and significantly improved trainee confidence. However, histological biopsy success rate and macroscopic correlation was poor. This is most likely related to difficulty in biopsying non-diseased pleura and possibly differences between macroscopic appearances of porcine and human pleura or inexperienced trainees’ inability to recognise pleura macroscopically. Experience was low even in a high-incidence region, suggesting simulated pleural biopsy training may be a useful adjunct.
Brown J et al. Abrams-Needle Pleural Biopsy Remains a Useful Investigation in Suspected Pleural Tuberculosis. Thorax 2012;67(Suppl 2):A113–A113.
Naicker TR et al. Validation of a novel resin-porcine thorax model for chest drain insertion training. Clinical medicine 2012;12:49–52.