|Year : 2006 | Volume
| Issue : 1 | Page : 12-15
|A comparison between Cope and Abrams needle in the diagnosis of pleural effusion
Alaa M Gouda, Tarek A Dalati, Nasser S Al-Shareef
King Saud Chest Hospital, Riyadh,& Ministry of Health, Kingdom of Saudi Arabia
Alaa M Gouda
King Saud Hospital, P. O Box 276977, Riyadh - 11314, Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
STUDY OBJECTIVE: To compare between Abrams and Cope needles pleural biopsy, as regard their diagnostic yield and complications in pleural effusions.
STUDY DESIGN: Retrospective chart analysis
SETTING: 140 bed community chest hospital, ministry of health, affiliated with teaching hospitals in Riyadh area.
MATERIALS AND METHODS: 57 patients (44 males and 13 females), with a mean age of 37.9 years (range, 17-80 years), who were admitted through July 1994 to June 1995, for management of pleural effusion.
INTERVENTION: Pleural biopsy was performed for all patients, using either cope needle (group 1: 22 patients), or Abrams needle (group 2: 35 patients).
MEASUREMENT: We recorded the type of pleural biopsy needle, final diagnosis and complications.
RESULTS: The overall diagnostic sensitivity in pleural effusions for Cope needle was 82% (18/22), compared to 54% (19/35) for Abrams needle. The diagnostic sensitivity in TB pleurisy for Cope needle was 85% (17/20), compared to 57.5 (19/33)% for Abrams needle ( P = 0.08).
The incidence of pneumothorax was 18% (4/22) with cope needle, compared to 8% (3/35) with Abrams needle ( P = 0.5) no other complications occurred with both needles.
CONCLUSION: Cope needle demonstrates a diagnostic sensitivity equal to that of Abrams needle, without increase in the incidence of pneumothorax.
Keywords: Cope needle, Abrams needle, pleural biopsy, pleural TB.
|How to cite this article:|
Gouda AM, Dalati TA, Al-Shareef NS. A comparison between Cope and Abrams needle in the diagnosis of pleural effusion. Ann Thorac Med 2006;1:12-5
Needle biopsy of the parietal pleura is useful in determining the cause of pleural effusion. It affords a simple, prompt, means of establishing a diagnosis in many patients, who would otherwise require longer and more complex procedures. The Vim-Silverman needle was used in the initial description of the technique. Since that time, closed needle pleural biopsy has proven its efficacy in the diagnosis of both tuberculous pleurisy and pleural carcinomatosis.,
Many different needle designs have been used,,, but the most popular are the cope and the abrams needles.
We used classic Abrams needle and Cope needle for pleural biopsy and we compared the diagnostic sensitivity and incidence of complications, for both needles.
| Materials and Methods|| |
A total of 112 patients were admitted over a one year period to our institute, for management of pleural effusion. 14 patients were found to have transudative pleural effusion and 98 patients had exudative pleural effusion. Complete data were available for 57 patients who underwent 57 closed pleural biopsy, which constitute our patients, who had been enrolled in this study.We retrospectively reviewed the outcome of needle biopsies on the parietal pleura. Cope needle and Abrams needle biopsies were performed, using the original techniques initially described., The decision of weather- performing parietal pleural biopsy using either Abrams needle or Cope needle, was the operator's choice.
However, most of the operators have reasonable skills in using Abrams needle and relatively less experience in using Cope needle, as Cope needle was only recently introduced to our institution.
We reviewed all cytological and histology results. Also, we reviewed the routine biochemical and hematological results, pleural fluid analysis, sputum and pleural fluid stains and cultures and the tuberculin test (Mantoux method).
Diagnosis has been established in 47 patients (37 patients by closed pleural needle biopsy, 3 patients via thoracoscopic biopsy, 4 patients by positive fluid and / or tissue culture for AFB and 3 patients had positive sputum for AFB by direct smear and culture) [Figure - 1]. Presumptive diagnosis was made in the remaining group of 10 patients, based on a consistent clinical presentation (prolonged and classic local and general constitutional symptoms, history of contact to diagnosed cases of tuberculosis, certain occupations and nationalities), highly positive tuberculin test (>10 mm), laboratory findings, pleural fluid cytological examination, clinical course and good clinical and radiological response to anti-tuberculosis therapy on subsequent follow up, with an endpoint cure of the patient and clearance of chest X-ray.
Based on the final diagnosis, 53 patients were diagnosed as having tuberculous pleural effusion and 4 cases were diagnosed to have malignant pleural effusion. The 57 patients were classified into 2 groups [Figure - 1]:
Group (1): Cope needle (22 patients) 20 patients with definitive diagnosis and 2 patients with presumptive diagnosis. The needle was diagnostic in 18 cases.
Group (2): Abrams needle (35 patients) 27 patients with definitive diagnosis and 8 patients with presumptive diagnosis. The needle was diagnostic in 19 cases.
We recorded the data on a standard worksheet and Statistical analysis was done using SPSS computer program for windows (ver 6.0 1993). Statistical comparison of the two groups was done using Yates' continuity correction, with Chi Square test (Mantel Haenszel) and Fisher's Exact Test.
We accepted a P < 0.05 as statistically significant.
| Results|| |
We have retrospectively studied the diagnostic yield of 57 pleural biopsy procedures, done in 57 patients over a one-year period. There were 44 males and 13 females, with the mean age range of 17 to 80 years. 10 were Saudi nationals (17%) and 47 of the non Saudi group. (83%) [Table - 1]. The patients were classified into 2 main groups:
Group (1): In 22 patients who underwent Cope needle biopsy procedures, the diagnosis has been established by the use of Cope pleural biopsy needle in 18/22 cases (17 cases with tuberculous pleural effusion and 1 case with malignant pleural effusion).
Group (2): In 35 patients who underwent Abrams needle biopsy procedures, Abrams needle biopsy was diagnostic in 19/35 cases, all with TB pleural effusion.
Overall, there were 53 patients with the diagnosis of TB pleurisy. Needle biopsy was diagnostic of TB pleurisy, if tissue showed granulomas in a patient with consistent clinicoradiographic picture and positive PPD (<10 mm), if granulomas had AFB, or if the biopsy specimen grew Mycobacterium tuberculosis in culture.
The diagnostic sensitivity for tuberculous pleurisy using both needles was 68% (36/53). The diagnostic sensitivity for tuberculous pleurisy was 85% (17/20) for group 1 (Cope needle) and 57.6% (19/33) for group 2 (Abrams needle). There was no difference in the diagnostic yield in TB pleurisy between both groups ( P = 0.08) [Figure - 2].
Only 4 patients out of 53 patients had PPD negative (0 mm) and 49 patients (92%) had PPD positive (<10 mm).In the present study, highly positive tuberculin test is highly suggestive, but not definitely diagnostic of TB as an etiology of pleural effusion. Sputum for AFB was positive in 3/53 patients (5.6%), similar to a previous report. Only 2/53 cases (3.7%) of the TB pleurisy were found to have bilateral pleural effusion. All cases were found to have moderate to massive pleural effusion, according to the criteria described before. Mycobacterium tuberculosis grew from pleural fluid culture, only in 4/53 patients. A total of 7/57 patients (12%) developed pneumothorax following biopsy procedures, which was consistent with previous reports. 4 cases out of 22 (18%) developed pnemothorax on using Cope needle and 3 cases out of 35(8%), on using Abrams needle ( P = 0.5) [Figure - 3]. 5 cases resolved spontaneously and 2 cases needed intercostal tube drainage that has been removed, without further complications.
No other complications were observed on using both needles.
| Discussion|| |
Closed needle biopsy of the parietal pleura has been of proven efficacy, in the diagnosis of pleural effusion of TB and metastatic carcinoma. Different needles,,,, and different techniques, for the same needle, have been used to improve the diagnostic yield and decrease the complications of closed pleural biopsy.
When using the classic technique described,,,,,, for Abrams and Cope needles, the incidence of Pneumothorax ranged from 3-15 %.,,,,,, 
In the current study, the incidence of pneumothorax was 8% (3/37) with Abrams needle and 18% (4/22) with Cope needle. The difference was statistically nil. ( P = 0.5).
Nevertheless, using Cope needle required more cooperation of the patients, so that they could exhale as maximally as they could, in an attempt to create less negative intrapleural pressure and thus minimize the incidence of pneumothorax.
The relatively higher incidence of pneumothorax with Cope needle compared to other studies,, thus can be explained by the small number of patients, poor patient selection and poor patient cooperation in this study.
5/7 cases who developed pneumothorax resolved spontaneously and 2 cases required intercostal tube.
The overall diagnostic sensitivity for tuberculous. pleural effusion on using closed pleural biopsy needle was 68% and in the range of 60 to 95%, which is described in the literature.,,,,,,
The diagnostic sensitivity for TB pleurisy on using Cope needle in our study was 85% (17/20 patients), which was in the higher range as described in the literature (60-95%),,,,,- while that of Abrams needle was 57.6% (19/35 patients), compared to 49.1, 58, 71, 62 and 75%, in previous reports.
The difference was not statistically significant between diagnostic yield of Abrams and Cope needles ( P = 0.08 using Chi square test for raw data), as shown by a previous studies.,,
The diagnosis has been established in 20 patients with false negative pleural biopsy specimen for TB by sputum (n=3), pleura fluid culture (n=4) or thoracoscopic biopsy (n=1). Presumptive diagnosis was made in 10 patients with TB pleurisy.
We concluded that the diagnostic yield of Cope and Abrams pleural biopsy needles are almost equal in the current study, with the same incidence of pneumothorax. Closed pleural biopsy needles, is a simple and relatively less invasive procedure, performed under local anesthesia, which will decrease the cost and length of hospital stay.
Pleural biopsy needle procedure is mainly as other procedures-operator dependent, that might give high diagnostic yield with low incidence of complications, specially pneumothorax, which can be minimized by mastering the technique, by patient cooperation and.patient selection.
Further studies designed to be in a prospective randomized fashion, or simultaneous needle biopsy in the same patient by the same operator, might be conducted to compare between the diagnostic yield of both Abrams and Cope needles.
| References|| |
|1.||De Francis, Kloks E. Needle biopsy of the parietal pleura. N Eng J Med 1955;252:948-9. |
|2.||Sahn SA. Stat of the art: The pleura. Am Rev Resp Dis 1988;138:184-234. [PUBMED] |
|3.||Ball WC Jr. Thoracocentesis and pleural biopsy. In : Sackner M, ed. Diagnostic technique in pulmonary disease. Marcel Dekker Inc: New York; 1981. p. 541-66. |
|4.||Ballestero RJ. A new reliable instrument for pleural biopsy. Chest 1972;61:303-4. [PUBMED] |
|5.||Carpenter RL, Lowell JR. Pleural biopsy and thoracocentesis by a new instrument. Dis Chest 1961;40:182-6. [PUBMED] |
|6.||Moghissi K. Anew type of pleural biopsy instrument. BMJ 1961;1:1543. |
|7.||Cope C. New pleural biopsy needle. JAMA 1958;167:1107-8. [PUBMED] |
|8.||Abrams LD. A pleural biopsy punch. Lancet 1958;1:30-1. [PUBMED] |
|9.||Ellner JJ. Pleural fluid and peripheral blood lymphocyte function in TB. Ann Int Med 1978;89:932. [PUBMED] |
|10.||Onadeko BO. TB pleural effusion: Clinical patterns and management in Nigerians. Tubercle 1978;59:269-75. [PUBMED] |
|11.||Rober WH, Waring JJ. Primary serofibrinous pleural effusion in military personnel. Am Rev Resp Dis 1955;71:616. |
|12.||Escudero BC, Garcia CM, Cuesta CB. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients. Arch Int Med 1990;150:6. |
|13.||Carl M, William A, Jhon H. A modified Abrams needle biopsy technique. Chest 1995;108:982-86. |
|14.||Raja OG, Lalor AJ. Modification to the technique of percutaneous pleural biopsy using Abram's needle. Br J Dis Chest 1980;74:285-6. [PUBMED] |
|15.||Kettel LJ, Cugel DW. Pleural biopsy. JAMA 1976;200:141-4. |
|16.||Mungall IP, Cowen PN, Cooke NT, Roach TC, Cooke NJ. Multiple pleural biopsy with the Abrams needle. Thorax 1980;35:600-2. [PUBMED] |
|17.||Reese O Jr, Mclean RL, Raaen TD. Acid fast bacilli in pleural biopsy. Arch Intern Med 1961;108:438-41. [PUBMED] |
|18.||Scerbo J, Keltz H, Stone DJ. A prospective study of closed pleural biopsies. JAMA 1971;218:377-80. [PUBMED] |
|19.||Cowie RL, Escreet BC, Goldstein B, Langton ME, Leigh RA. Pleural biopsy: A report of 750 biopsies performed using Abram's pleural biopsy punch. S Afr Med J 1983;64:92-5. [PUBMED] |
|20.||Tomlinson JR, Sahnm SA. Invasive procedures in the diagnosis of pleural disease. Semin Respir Med 1987;9:30-6. |
|21.||Donaho RF, Katz S, Matthews MJ. Pleura biopsy as an aid in the diagnosis of pleural effusion. Am Int Med 1958;48:344-8. |
|22.||Sahn SA. Pleural manifestations of pulmonary disease. Hosp Pract Hosp Ed 1981;16:73-9, 83. [PUBMED] |
|23.||Chertien J. Needle pleural biopsy. The pleura in health and disease. Marcel Dekker: New York 1985. p. 631-42. |
|24.||McAleer JJ, Murphy GJ, Quinn RJ. Needle biopsy of the pleura in the diagnosis of pleural effusion. Ulster Med J 1987;56:54-7. [PUBMED] |
|25.||Canto A, Rivas J, Saumench J, Morera R, Moya J. Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin. Chest 1983;84:176-9. [PUBMED] |
|26.||Poe RH, Israel RH, Utel MJ, Hall WJ, Greenblatt DW, Kallay MC. Sensitivity, specifity and predictive values of closed pleural biopsy. Arch Int Med 1984;144:325-8. |
|27.||Levine H, Metzger W, Lacera D, Kay L. Diagnosis of tuberculous pleurisy by the culture of pleural biopsy specimen. Arch Int Med 1970;126:269-71. [PUBMED] |
|28.||Scharer L, McClement JH. Isolation of tubercle bacilli from needle biopsy specimen of parietal pleura. Am Rev Resp Dis 1968;97:466-8. [PUBMED] |
|29.||Hirsch A, Ruffie P, Nebut M, Bignon J, Chretien J. Pleural effusion: Laboratory tests in 300 cases. Thorax 1979;34:106-12. [PUBMED] |
|30.||Mestitz P, Pollard AC, Purves MJ. Needle biopsy of the parietal pleura. Lancet 1957;2:873. |
|31.||Mestitz P, Purves MJ, Polland AC. Pleural biopsy in the diagnosis of pleural effusion: A report of 200 cases. Lancet 1958;2:1349-53. |
|32.||Morrone N, Algranti E, Barreto E. Pleural biopsy with Cope and Abrams needles. Chest 1987;92:1050-2. [PUBMED] |
|33.||Al-Shimemeri AA, Al-Ghadeer HM, Giridhar HR. Diagnostic yield of closed pleural biopsy in exudative pleural effusion. Saudi Med J 2003;24:282-6. [PUBMED] |
|34.||Mungall IP, Cowen PN, Cooke NT, Roach TC, Cooke NJ. Multiple pleural biopsy with the Abrams needle. Thorax 1980;35:600-2. [PUBMED] |
|35.||McLean AN, Bicknell SR, McAlpine LG, Peacock AJ. Investigation of pleural effusion: An evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with Abram's needle biopsy. Chest 1998;114:150-3. [PUBMED] [FULLTEXT]|
|36.||Tomlinson JR. Closed pleural biopsy. A prospective study of dual biopsy sites. Am Rev Respir Dis 1990;133:56A. |
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]
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