Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of XXXX in @entity1143 : a randomised controlled trial.

@entity1143 @entity1 @entity5 @entity2615 @entity3483 @entity456
BACKGROUND: Over 200000 @entity1143 are attributable to @entity5 in the UK and USA every year. Cytological examination of pleural fluid classifies about 60% of malignant effusions. Pleural biopsy needs to be done in the remaining cases. We aimed to assess whether CT-guided biopsy is an improvement over standard pleural biopsy in this setting. METHODS: 50 consecutive @entity1 with cytologically negative suspected @entity3483 were recruited. All had a contrast-enhanced thoracic CT scan to assess @entity456 . @entity1 were randomly allocated, stratified by baseline @entity456 , to either Abrams' pleural biopsy (standard care; n=25) or CT-guided cutting needle biopsy (n=25). Sensitivity for @entity5 from the biopsy specimen was the primary endpoint, with the @entity1 's clinical outcome after 1 year being the diagnostic gold standard. Analysis was per protocol. FINDINGS: Three @entity1 did not undergo biopsy. Abrams' biopsy correctly diagnosed @entity5 in eight of 17 @entity1 (sensitivity 47%, specificity 100%, negative predictive value 44%, positive predictive value 100%). CT-guided biopsy correctly diagnosed @entity5 in 13 of 15 (sensitivity 87%, specificity 100%, negative predictive value 80%, positive predictive value 100%; difference in sensitivity between Abrams' and CT-guided 40%, 95% CI 10-69, p=0.02). Diagnostic advantage was similar in @entity1 proving to have @entity2615 . INTERPRETATION: Primary use of CT-guided biopsy would avoid doing at least one Abrams' biopsy for every 2.5 CT-guided biopsies undertaken. In cytology-negative suspected @entity3483 , CT-guided pleural biopsy is a better diagnostic test than Abrams' pleural biopsy.
