• Muzaffer Metintas, Guntulu Ak, Huseyin Yildirim, Emine Dundar, Nevin Aydin, Sinan Erginel, Fusun Alatas, Senay Yilmaz, and Selma Metintas.
• Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey; Lung and Pleural Cancers Clinical and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey. Electronic address: muzaffermetintas@gmail.com.
• Chest. 2024 Mar 28.

BackgroundImage-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy.Research QuestionWhich biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion?Study Design And MethodsThis prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups.ResultsThe false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107).InterpretationMT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT.Trial RegistryClinicalTrials.gov; No.: NCT05428891; URL: www.Clinicaltrialsgov.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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