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A direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-cut needle biopsies for pleural tuberculosis
  1. Coenraad F N Koegelenberg*,
  2. Chris T Bolliger,
  3. Johan Theron,
  4. Gerhard Walzl,
  5. Colleen Anne Wright,
  6. Mercia Louw,
  7. Andreas H Diacon
  1. 1 University of Stellenbosch, South Africa
  1. Correspondence to: Coenraad F Koegelenberg, Medicine, University of Stellenbosch, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Stellenbosch, P O Box 19063, Tygerberg, Cape Town, 7505, South Africa; coeniefn{at}


Background: Tuberculous pleuritis remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological and/or microbiological confirmation on pleural tissue is the gold standard for its diagnosis. Uncertainty remains regarding the choice of closed pleural biopsy needles.

Objectives: This prospective study compared ultrasound-assisted Abrams and Tru-cut needle biopsies with regards to their diagnostic yield for pleural tuberculosis.

Methods: We enrolled 89 patients (38.7+/-16.7 years; 54 males) with pleural effusions and a clinical suspicion of tuberculosis. Transthoracic ultrasound was performed on all, whereafter patients were randomly assigned to undergo either four or more Abrams needle biopsies followed by four or more Tru-cut needle biopsies or vice versa. Medical thoracoscopy was performed on cases with nondiagnostic closed biopsies. Histological and/or microbiological proof of tuberculosis on any pleural specimen was considered the gold standard for pleural tuberculosis.

Results: Pleural tuberculosis was diagnosed in 66 patients, alternative diagnoses established in 20 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 81 patients (91.0%) and were diagnostic for TB in 54 patients (sensitivity=81.8%), whereas Tru-cut needle biopsy specimens only contained pleural tissue in 70 patients (78.7%, p=0.015) and were diagnostic in 43 patients (sensitivity=65.2%, p=0.022).

Conclusions: US-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleura and have a significantly higher diagnostic sensitivity for pleural tuberculosis.

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