Analysis of "dry" mesothelioma with ultrasound guided biopsies

Our plain-English summary of Analysis of "dry" mesothelioma with ultrasound guided biopsies, by J.A. Stigt, J.E. Boers, H.J. Groen (Lung Cancer, 2012).

The study

• Authors: J.A. Stigt, J.E. Boers, H.J. Groen
• Journal: Lung Cancer
• Published: 2012;78(3):229-33
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Image-guided sampling of the thickened pleura is a sensitive approach in patients with malignant pleural mesothelioma with pleural effusion. Malignant pleural mesothelioma presenting without effusion however is more of a diagnostic challenge. In this study we report the diagnostic yield and complications of ultrasound-guided cutting needle biopsies in this particular category of patients.

Methods: A retrospective database analysis from September 2007 until January 2012 was performed in 56 patients with malignant pleural mesothelioma. Clinical characteristics and results of diagnostic evaluations were analysed.

Results: Of the 56 patients with malignant pleural mesothelioma, 20 patients presented without pleural effusion of with locular effusion. Ultrasound-guided cutting needle biopsy was performed in 14/20 patients with a diagnostic accuracy of 80%. Only 1 patient had mild haemoptysis immediately following biopsies.

Conclusion: Diagnosing patients with pleural thickenings suspect for malignant mesothelioma without pleural effusion or with loculated pleural effusion is effective and safe with ultrasound-guided cutting needle biopsies.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective study from one hospital in Zwolle, the Netherlands, reviewed how 56 consecutive patients with malignant pleural mesothelioma were diagnosed from September 2007 to January 2012. Twenty had pleural thickening without massive fluid around the lung, some with loculated (walled-off) fluid; the authors called this so-called "dry" mesothelioma. The other 36 had massive pleural effusion. The study did not examine asbestos exposure. Among the 20 without massive effusion, ultrasound-guided cutting needle biopsy provided the diagnosis in 12. In all, 20 patients (14 without and 6 with massive effusion) were assessed with this method, and in some of them no core sample could be taken. Of these 20, 17 were diagnosed this way. For the 14 without massive effusion, the authors reported a diagnostic accuracy of 80%. Over 22 procedures, one patient had a single mild episode of coughing up blood, and no collapsed lung (pneumothorax) was seen. The authors concluded that the technique was safe and highly accurate for these patients. They noted that the study was retrospective and small, that it had too few CT-guided biopsies to compare the two guidance methods, and that it did not monitor tumour spread along the needle track.

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 single-centre analysis of a patient database (case series of diagnostic procedures)
• Who was studied: 56 consecutive patients diagnosed with malignant pleural mesothelioma at Isala Klinieken, Zwolle, the Netherlands, from September 2007 to January 2012. Of these, 36 had massive pleural effusion and 20 had pleural thickening with or without loculated (walled-off) pleural fluid. Of the 20 patients assessed with ultrasound-guided biopsy, 19 were male and 1 was female.
• Exposure: Not reported. The article does not describe the patients' asbestos exposure. The procedure evaluated was ultrasound-guided cutting needle (14G core) biopsy of the pleura.
• Main results:
  • Among the 36 patients with massive pleural effusion, thoracoscopy provided the diagnosis in 23 of 36.
  • Among the 20 patients without prominent pleural effusion, ultrasound-guided cutting needle biopsy provided the diagnosis in 12 of 20.
  • Twenty patients (14 without massive effusion, 6 with massive effusion) were assessed with ultrasound-guided cutting needle biopsy. In this group, 17 of 20 received a definitive diagnosis of malignant pleural mesothelioma this way, and 2 of them needed a second biopsy. In some of the 20, no core biopsy could be obtained: in one patient the needle could not be advanced, in one no solid structure was seen, and one had only fluid aspiration.
  • The ultrasound-guided biopsy attempt was non-diagnostic in 3 of the 20 patients assessed with it. One of these patients had only ultrasound-guided aspiration of loculated fluid, because the tumour mass could not be reached with a cutting needle.
  • For the 14 patients without massive effusion who underwent ultrasound-guided cutting needle biopsy, the authors reported a diagnostic accuracy of 80%.
  • Across 22 ultrasound-guided biopsy procedures, 1 patient had mild haemoptysis (coughing up blood). Patients had no significant pain, and no pneumothorax was observed.
• The authors' conclusion: The authors concluded that ultrasound-guided cutting needle biopsy was safe and had high diagnostic accuracy for patients with malignant pleural mesothelioma presenting without massive pleural effusion.
• Limitations the authors state:
  • The study was retrospective and included a small number of patients.
  • Too few CT-guided biopsies were performed to compare ultrasound and CT guidance.
  • The study did not monitor for tumour seeding along the needle track.
  • Pleural thickness was not measured by ultrasound during the biopsy. It was measured afterwards on CT scans.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Ultrasound, Pleura, Pleural Mesothelioma, Pleural Effusion, Needle Biopsy, Pleural Thickening, Malignant Mesothelioma.

Related studies

• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• Ultrasound-guided medical thoracoscopy in the absence of pleural effusion — G. Marchetti, A. Valsecchi, et al. (2015)
• Confocal Laser Endomicroscopy as a Guidance Tool for Pleural Biopsies in Malignant Pleural Mesothelioma — L. Wijmans, P. Baas, et al. (2019)

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