Differentiating Pleural Fluid Cytology, Abrams Biopsy, and Pleuroscopy In Malignant Pleural Effusion

Abstract

Introduction: Malignant pleural effusion (MPE) frequently occurs in advanced-stage malignancies and is typically associated with symptoms such as dyspnea and thoracic pain. Accurate diagnosis is essential for establishing prognosis and directing suitable oncological treatment. Objective: This literature review aims to compare pleural fluid cytology, Abrams needle biopsy, and pleuroscopy for diagnosing malignant pleural effusion, focusing on diagnostic sensitivity, advantages, limitations, and clinical applications. Methods: This study involved a narrative literature review of published research assessing the diagnostic efficacy of pleural fluid cytology, closed pleural biopsy with the Abrams needle, and medical thoracoscopy (pleuroscopy) in patients with suspected malignant pleural effusion. Results: Pleural fluid cytology exhibited a diagnostic sensitivity that varied between approximately 40% and 70%, showing increased yields in adenocarcinoma and reduced sensitivity in mesothelioma. Abrams needle biopsy demonstrated a moderate sensitivity ranging from 60% to 80%, especially when conducted with image guidance. Pleuroscopy demonstrated the highest diagnostic yield, surpassing 90%, owing to direct visualization of the pleura and the capacity to acquire targeted biopsies. Conclusion: Pleuroscopy provides the highest diagnostic accuracy for malignant pleural effusion when resources and expertise are accessible. Pleural fluid cytology and Abrams needle biopsy are important diagnostic methods, particularly in resource-constrained environments.