Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma

Our plain-English summary of Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma, by R.F. Adams, W. Gray, R.J. Davies, et al (Chest, 2001).

The study

• Authors: R.F. Adams, W. Gray, R.J. Davies, F.V. Gleeson
• Journal: Chest
• Published: 2001;120(6):1798-802
• Cited by: 78 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Study Objectives: Pleural fluid cytology and non-image-guided Abrams or Cope biopsies have sensitivities of approximately 30% for detecting malignant mesothelioma, and thoracoscopic biopsy has a sensitivity of approximately 90%. The difference between these two probably relates to obtaining adequate tissue. The use of immunohistochemical stains allows a firm diagnosis to be made from relatively small samples. This study explores whether percutaneous image-guided cutting needle biopsy (CNB) combined with immunohistochemistry is accurate in diagnosing pleural thickening due to mesothelioma.

Design: Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist.

Setting: Teaching hospital chest radiology department.

Patients: Twenty-one adult patients with a final diagnosis of malignant mesothelioma were identified from 53 consecutive patients who underwent percutaneous image-guided CNB. All 21 patients had pleural thickening identified on contrast-enhanced CT, and all had a final histologic diagnosis of mesothelioma confirmed by postmortem examination or thoracoscopy.

Interventions: Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients.

Measurements And Results: A correct histologic diagnosis of malignant mesothelioma was made by CNB in 18 patients (86% sensitivity and 100% specificity). Complications included one chest wall hematoma and a small hemoptysis. Four patients with a pleural thickness of < or = 5 mm underwent biopsy, and all specimens were diagnostic for mesothelioma.

Conclusions: Image-guided percutaneous CNB of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma. Pleural thickening of < or = 5 mm may be successfully sampled.

In plain English

This retrospective study reviewed the records of 53 consecutive patients with pleural thickening on contrast-enhanced CT who had a cutting needle biopsy of the pleura guided by CT or ultrasound. It focused on the 21 adults whose final diagnosis of malignant mesothelioma was confirmed at postmortem examination or by thoracoscopy. Guidance was by CT in 15 patients and by ultrasound in 6, using 14-gauge or 18-gauge needles. The needle biopsy correctly diagnosed mesothelioma in 18 of the 21 (sensitivity 86%, specificity 100%). Two biopsies showed only fibrosis and chronic inflammation, and one was judged more likely to be carcinoma. All four patients whose pleural thickening was 5 mm or less had a diagnostic biopsy. Complications were one small episode of coughing up blood (hemoptysis) and one collection of blood in the chest wall (hematoma). In every patient with a pleural effusion, pleural fluid cytology was nondiagnostic. The article did not report the patients' asbestos exposure. The authors concluded that the procedure is safe, with 86% sensitivity for detecting malignant mesothelioma.

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 image-guided cutting needle biopsies of the pleura (a study of diagnostic accuracy)
• Who was studied: 21 adult patients with a final diagnosis of malignant mesothelioma, out of 53 consecutive patients who had image-guided pleural cutting needle biopsy. All had pleural thickening on contrast-enhanced CT. Each diagnosis was confirmed at postmortem examination or by thoracoscopy.
• Exposure: No asbestos exposure data were reported. The study evaluated a diagnostic procedure: cutting needle biopsy with 14-gauge or 18-gauge needles, guided by ultrasound in 6 patients and by CT in 15.
• Main results:
  • Cutting needle biopsy correctly diagnosed mesothelioma in 18 of the 21 mesothelioma patients (sensitivity 86%, specificity 100%).
  • In two of the mesothelioma patients the biopsy was nondiagnostic: adequate specimens showed fibrosis and chronic inflammation but no malignancy.
  • In a third mesothelioma patient, later proven at postmortem examination, the biopsy was read as more likely carcinoma.
  • All four patients with pleural thickness of 5 mm or less at the biopsy site had biopsies diagnostic for mesothelioma.
  • Complications were one small hemoptysis (after CT-guided biopsy) and one chest wall hematoma (after ultrasound-guided biopsy).
  • Of the 17 mesothelioma patients who had fine-needle aspiration, cytology was:
• diagnostic in 2
• suggestive of mesothelioma in 7
• diagnostic of carcinoma in 1
• atypical mesothelial cells in 2
• nondiagnostic in 5
  • Pleural fluid cytology was nondiagnostic in all patients with a pleural effusion (14 of the 21 had an effusion at the time of biopsy).
  • Of four patients whose cutting needle biopsy was diagnostic of mesothelioma and who also had thoracoscopic biopsies, only two of the thoracoscopic biopsies were diagnostic.
• The authors' conclusion: The authors concluded that image-guided percutaneous cutting needle biopsy of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Needle Biopsy, Pleura, Malignant Mesothelioma, Fluid Cytology, Thoracoscopic Biopsy, Immunohistochemistry, Pleural Thickening, Mesothelioma.

Related studies

• Percutaneous image-guided fine-needle aspiration of peritoneal lesions — L.J. Layfield, E.V. Gopez (2003)
• A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma — B.T. Welch, P.W. Eiken, et al. (2017)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• CT-guided core-needle biopsy in omental pathology — F. Pombo, E. Rodriguez, et al. (1997)
• The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura — H.D. Beauchamp, N.K. Kundra, et al. (1992)
• Malignant pleural mesothelioma: US-guided histologic core-needle biopsy — A. Heilo, A.E. Stenwig, et al. (1999)

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