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.