Image-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. Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? This 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. The 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 ( = .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 ( = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; = .107). MT 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. ClinicalTrials.gov; No.: ; URL:

中文翻译：

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图像辅助胸膜穿刺活检或内科胸腔镜检查：哪种方法适合哪种患者？ – 随机对照试验

图像引导或辅助穿刺活检以及医学胸腔镜 (MT) 的广泛使用显着提高了胸膜疾病的诊断准确性。然而，对于哪些胸腔积液患者应接受 MT 以及哪些患者应首先接受图像引导或辅助穿刺活检以确保更高的诊断准确性，尚未达成共识。哪种活检方法更适合哪种患者，在胸腔积液的诊断中提供最高的诊断准确性？这项前瞻性、随机、平行研究纳入了 228 名未确诊的渗出性胸腔积液患者。根据 CT 扫描结果将患者分为两组。第 1 组仅包括胸腔积液患者。第 2 组包括除胸腔积液外还伴有胸膜增厚或病变的患者。每组患者被随机分配至图像辅助 Abrams 针活检 (IA-ANPB) 组或 MT 组。确定了两组的诊断敏感性、可靠性和安全性。第 1 组中 IA-ANPB 组的假阴性率为 30.3%，MT 组为 3.1%。第 2 组中 IA-ANPB 组的假阴性率为 11.9%，MT 组的假阴性率为 4.7%。第 1 组中，敏感性IA-ANPB 组的率为 69.7%，阴性似然比为 0.30。 MT 组的比率相同，分别为 96.9% 和 0.03 (= .009)。在第 2 组中，IA-ANPB 组的这些值为 88.1% 和 0.12，MT 组的这些值为 95.4% 和 0.05 (= .207)。两种活检方法的并发症发生率没有差异（分别为 8.5% 和 15.8%；= .107）。 MT 对所有胸腔积液患者的诊断均显示出较高的成功率。然而，对于胸腔积液和相关胸膜增厚或病变的患者，IA-ANPB 显示出与 MT 相似的诊断成功率。因此，在后一种情况下，IA-ANPB 可能优于 MT。临床试验.gov；不。： ;网址：