Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma

Our plain-English summary of Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma, by M. Sperandeo, L. Dimitri, C. Pirri, et al (Chest, 2014).

The study

• Authors: M. Sperandeo, L. Dimitri, C. Pirri, F.M. Trovato, D. Catalano, G.M. Trovato
• Journal: Chest
• Published: 2014;146(5):e178-e179
• Type of article: Letter, Comment
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, written in response to a study by Hallifax et al on physician-based ultrasound-guided pleural biopsy, the authors, based in Italy, described their use of thoracic ultrasound (TUS) and TUS-guided fine-needle aspiration biopsy (FNAB) as a primary intervention procedure, rather than waiting for thoracoscopy to fail, in patients with malignant pleural mesothelioma (MPM) or lung cancer (LC). They reassessed TUS imaging, diagnostic yield and complications using the records of 133 patients with MPM and 801 patients with LC. TUS-guided FNAB was performed in 55 of the MPM patients and in all 801 LC patients (2008-2013), using 20-gauge needles and ultrasound transducers with a central hole for needle passage. Specimens were 1.0-2.5 cm long. The procedure was repeated in 20 patients because of insufficient sampling. Four patients had a partial, self-limited pneumothorax, and no severe complication was observed. TUS signs seen in histologically confirmed MPM were irregular thickening of the pleural line and associated micronodules (5-10 mm). A lower percentage showed plaque nodulations (5-10 mm), all with slight or relevant pleural effusion. The authors reported that CT and TUS findings agreed more closely in MPM than in LC, probably because of the tumour's pleural-subpleural position. They concluded that CT remains the primary imaging method, but TUS is a valuable complementary imaging method and the primary diagnostic intervention procedure. They added that it could contribute to noninvasive screening of people with environmental and occupational risk for MPM and LC.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a short letter to the editor of Chest, replying to an article by Hallifax and colleagues on ultrasound-guided pleural biopsy. The authors, from San Giovanni Rotondo and Catania, Italy, described using thoracic ultrasound and ultrasound-guided fine-needle aspiration biopsy as a first-line procedure. They reported analyzing the records of 133 patients with malignant pleural mesothelioma and 801 patients with lung cancer. Between 2008 and 2013, biopsy with thin 20-gauge needles was done in 55 of the mesothelioma patients and in all 801 lung cancer patients. Samples were 1.0 to 2.5 cm long. The procedure was repeated in 20 patients because too little tissue was obtained. Four patients had a partial collapsed lung (pneumothorax) that resolved on its own, and no severe complication was observed. The authors gave no figure for diagnostic yield. In confirmed mesothelioma, ultrasound showed irregular pleural thickening and small nodules, with fluid around the lung. The authors noted that ultrasound images are not specific for mesothelioma and that only the biopsy confirms the diagnosis. They concluded that ultrasound is a valuable complement to CT scanning, which they said remains the primary imaging method. The letter did not study asbestos exposure.

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: Letter to the editor (correspondence) reporting the authors' review of their own patients' records; not a formal research article
• Who was studied: Records of 133 patients with malignant pleural mesothelioma and 801 patients with lung cancer. Biopsy was done in 55 of the mesothelioma patients and all 801 lung cancer patients (2008-2013). The authors are based in San Giovanni Rotondo and Catania, Italy. The letter does not state where the patients were treated.
• Exposure: No asbestos or other exposure was studied. The subject was a diagnostic procedure: thoracic ultrasound and ultrasound-guided fine-needle aspiration biopsy with 20-gauge needles.
• Main results:
  • The thin needles gave specimens 1.0 to 2.5 cm long, which the authors described as adequate.
  • The procedure was repeated in 20 patients because of insufficient sampling. No total number of procedures was given as a denominator.
  • Four patients had a partial, self-limited pneumothorax, and no severe complication was observed.
  • In histologically confirmed mesothelioma, ultrasound showed irregular thickening of the pleural line with micronodules of 5-10 mm. A lower percentage showed plaque nodulations of 5-10 mm. All had slight or relevant pleural effusion. No percentages were given.
  • The authors stated that agreement between CT and ultrasound images was greater in mesothelioma patients than in lung cancer patients, probably because of the tumor's position at the pleura. No figures were given.
  • The authors stated that ultrasound imaging is not specific for mesothelioma, and that only the biopsy tissue assessment confirms the diagnosis.
• The authors' conclusion: The authors concluded that thoracic ultrasound is a valuable complementary imaging modality and their primary diagnostic intervention procedure, while CT scanning remains the primary imaging modality.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Ultrasound, Fine-Needle Aspiration, Lung Cancer, Mesothelioma, Pleural Biopsy, Thoracoscopy, Pleural Mesothelioma, Pneumothorax.

Related studies

• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy — J.P. Corcoran, I. Psallidas, et al. (2015)
• Malignant pleural mesothelioma: US-guided histologic core-needle biopsy — A. Heilo, A.E. Stenwig, et al. (1999)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)

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