A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma

Our plain-English summary of A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma, by B.T. Welch, P.W. Eiken, T.D. Atwell, et al (Cardiovascular and Interventional Radiology, 2017).

The study

• Authors: B.T. Welch, P.W. Eiken, T.D. Atwell, T. Peikert, E.S. Yi, F. Nichols, G.D. Schmit
• Journal: Cardiovascular and Interventional Radiology
• Published: 2017;40(6):860-863
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma.

Materials And Methods: Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)].

Results: Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract.

Conclusion: Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

In plain English

Researchers at Mayo Clinic in Rochester, Minnesota, reviewed records of patients with confirmed malignant pleural mesothelioma who had a CT- or ultrasound-guided core needle biopsy between 2002 and 2016. Asbestos exposure was not studied. Thirty-two patients had 33 biopsies: 27 used CT guidance and 6 used ultrasound. In 24 patients (75%), the first biopsy confirmed mesothelioma. Eight biopsies were counted as false negatives. Of those patients, 6 were later diagnosed by video-assisted thoracic surgery (VATS) and 1 by a repeat needle biopsy. The remaining patient received chemotherapy because the initial pathology strongly favored mesothelioma and the patient had multiple comorbidities. The authors calculated an overall sensitivity of 81%. No clinically significant complications were seen, and no patient needed hospitalization or a chest tube. No tumor seeding along the biopsy tract was found over a mean 11 months of imaging follow-up. One of the 6 VATS patients developed port seeding after surgery. The authors concluded that the biopsy achieved acceptable sensitivity and may warrant consideration as a first-line option. They noted that the study was retrospective, spanned nearly 15 years, and used no standardized biopsy protocol.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of an institutional biopsy database and clinical data repository (single institution)
• Who was studied: 32 patients with a pathologic diagnosis of malignant pleural mesothelioma who underwent 33 percutaneous image-guided core needle biopsies of the pleura at Mayo Clinic, Rochester, Minnesota, between January 1, 2002, and January 1, 2016. Patients who had open surgical biopsy before any attempt at needle sampling were excluded.
• Exposure: Asbestos exposure was not assessed. The study examined percutaneous image-guided core needle biopsy: 27 procedures were CT-guided and 6 were ultrasound-guided. Twelve used an 18-gauge device and 21 a 20-gauge device, with a mean of 4 needle passes (range 2 to 8).
• Main results:
  • In 24 of the 32 patients (75%), the first needle biopsy confirmed malignant pleural mesothelioma.
  • Of the 8 false-negative biopsies, 6 patients were confirmed by VATS and 1 by repeat percutaneous biopsy. The remaining patient was treated with chemotherapy because the initial pathology strongly favored mesothelioma and the patient had multiple comorbidities.
  • The overall sensitivity of percutaneous core needle biopsy for diagnosing malignant pleural mesothelioma was 81%.
  • Among the 8 false-negative biopsies, 3 were sarcomatoid subtype, and 1 each was epithelioid, desmoplastic, and biphasic. Six of the 8 (75%) used a 20-gauge device.
  • No clinically significant complications (CTCAE grade 3 or above) were observed. No patient required hospitalization or chest tube placement because of the biopsy.
  • No biopsy tract seeding was found during a mean imaging follow-up of 11 months. Of the 6 patients who underwent VATS, 1 developed port seeding after the surgery.
• The authors' conclusion: The authors concluded that percutaneous core needle biopsy achieved acceptable diagnostic sensitivity, with no clinically significant complications or tract seeding identified in this study. They added that it may warrant consideration as a first-line option for diagnosis.
• Limitations the authors state:
  • The study was retrospective and covered a long time period (nearly 15 years), which brought variation in the number and experience of the doctors doing the procedures.
  • No standardized biopsy protocol was used. The choice of image guidance, device size, and number of core samples was left to the individual doctor.
  • Real-time cytology assessment of the biopsy was not used.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Biopsy, Pleural Mesothelioma, Mesothelioma, Needle Biopsy, Pneumothorax.

Related studies

• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Percutaneous image-guided fine-needle aspiration of peritoneal lesions — L.J. Layfield, E.V. Gopez (2003)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• CT-guided core-needle biopsy in omental pathology — F. Pombo, E. Rodriguez, et al. (1997)
• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)

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