Bibby Anna C, Maskell Nick A
Academic Respiratory Unit, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
Curr Opin Pulm Med. 2016 Jul;22(4):392-8. doi: 10.1097/MCP.0000000000000258.
Pleural biopsies are often necessary if a pleural effusion remains undiagnosed after radiological imaging and pleural fluid analysis. There are many methods of obtaining pleural biopsies, including blind or image-guided procedures, closed-bevel or cutting-edge needles, and percutaneous or thoracoscopic approaches. This article will review recent research relating to these methods, aiming to provide an overview of the strengths and limitations of each technique.
Historically pleural biopsies were undertaken using a blind closed 'Abrams' needle method. However, low diagnostic yields and high complication rates are seen with this technique compared with newer methods. Recent research compares image-guided, cutting-needle approaches to traditional Abrams biopsies, and evaluates the role of medical thoracoscopy in comparison to other techniques.
Thoracoscopic biopsies are the gold standard for investigating pleural disease. However, this service is not universally available and may be unsuitable for some patients. Image-guided cutting-needle biopsies under computed tomography or ultrasound guidance have high diagnostic rates and are useful in a wide patient population. The main role of Abrams biopsies is in the diagnosis of tuberculous pleuritis in resource-poor settings.
如果胸腔积液在影像学检查和胸腔积液分析后仍未确诊，通常需要进行胸膜活检。获取胸膜活检的方法有很多种，包括盲法或影像引导操作、闭式斜面针或切割针以及经皮或胸腔镜途径。本文将综述与这些方法相关的最新研究，旨在概述每种技术的优缺点。
过去，胸膜活检采用盲法闭式“Abrams”针技术。然而，与新方法相比，该技术的诊断率较低且并发症发生率较高。近期研究将影像引导的切割针方法与传统的Abrams活检进行了比较，并评估了内科胸腔镜与其他技术相比的作用。
胸腔镜活检是诊断胸膜疾病的金标准。然而，这项服务并非普遍可用，可能不适用于某些患者。在计算机断层扫描或超声引导下进行的影像引导切割针活检诊断率高，适用于广泛的患者群体。Abrams活检的主要作用是在资源匮乏地区诊断结核性胸膜炎。
