Pleural biopsy in the diagnosis of malignant mesothelioma

Our plain-English summary of Pleural biopsy in the diagnosis of malignant mesothelioma, by A. Herbert, P.J. Gallagher (Thorax, 1982).

The study

• Authors: A. Herbert, P.J. Gallagher
• Journal: Thorax
• Published: 1982;37(11):816-21
• Cited by: 41 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In an attempt to distinguish reactive from neoplastic mesothelial proliferation, the histological material and clinical records of 153 patients on whom open or closed pleural biopsies were performed during 1976 were reviewed. In six of the 10 patients subsequently shown to have malignant mesothelioma the specimens from closed pleural biopsy had been reported as negative or equivocal but in retrospect showed changes not observed in reactive pleurisy. These included papillary mesothelial proliferation, exfoliated papillae, sheets of atypical mesothelial cells, and abnormal fibroblastic proliferation. In contrast, in inflammatory conditions the mesothelial lining was usually replaced by granulation tissue, although sheets or clumps of exfoliated mesothelial cells were often present in the corresponding pleural fluid clot. Some multilayering of parietal mesothelium was occasionally seen in chronic pleurisy and around metastases.

In plain English

This Southampton hospital study reviewed the tissue material and clinical records of 153 patients (95 men and 58 women) who had pleural biopsies in 1976. The aim was to find features that could help tell malignant mesothelioma apart from reactive, non-cancerous changes in closed needle biopsies of the pleura. In 43 of the 95 closed biopsies, only muscle, fat or fibrin was retrieved, so the biopsy was of no diagnostic value. Only 22 contained mesothelial tissue. On review, the authors judged that seven closed biopsy specimens from six patients showed changes that should be regarded as neoplastic. These were papillary growth of mesothelial cells (three patients), haphazard fibroblastic growth (two) and sheets of malignant-looking cells resembling shed mesothelium (one). Five of these six later had mesothelioma confirmed histologically. In pleural tissue from patients without mesothelioma, the authors found no papillary proliferation of the surface mesothelial lining. They concluded that papillary structures with connective tissue cores are a positive indication for thoracoscopy or thoracotomy, although they may not by themselves be diagnostic. The article reports no measurements of 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: Retrospective review of one hospital laboratory's pleural biopsy and pleural fluid clot material from one year, with clinical follow-up
• Who was studied: 153 patients (95 men, 58 women; mean age 61, range 16 to 87) who had pleural biopsies during 1976 at the Southampton hospitals. The material comprised 95 closed needle or drill biopsies (72 patients), 23 open pleural biopsies or pleurectomies (23 patients) and 158 sections of clots from pleural aspirates (110 patients). Ten patients, all men, had mesothelioma.
• Exposure: The article reports no asbestos exposure information or measurements for the patients. It mentions asbestos only to note that asbestos-associated pleural diseases are relatively common in the community served by the Southampton hospitals.
• Main results:
  • Of 95 closed pleural biopsies, 43 retrieved only skeletal muscle, adipose tissue or fibrin and were of no diagnostic value.
  • Only 22 of the 95 closed biopsy specimens included mesothelial tissue.
  • In retrospect, seven closed biopsy specimens from six patients showed mesothelial proliferative changes that the authors regarded as neoplastic.
  • Five of those six patients later had histological confirmation of mesothelioma at thoracotomy or necropsy. The sixth had a history strongly suggestive of mesothelioma but died without further investigation.
  • The changes were papillary proliferation of mesothelial cells (three patients), haphazard fibroblastic proliferation (two patients) and solid exfoliated malignant mesothelial cells (one patient).
  • In open biopsies from empyemas and non-specific fibrous pleurisy, the mesothelial lining was almost always absent and was replaced by inflammatory cells and granulation tissue.
  • In the absence of malignant mesothelioma, the authors found no case of papillary proliferation of the surface mesothelium of the pleura. In chronic fibrous pleurisy, a single layer and occasionally multiple layers of mesothelial cells could be present on the parietal pleura.
  • A firm diagnosis of neoplasia was made in 20% of pleural fluid clots, compared with 14% of needle biopsy specimens.
  • In pleural fluid clots, malignant mesothelioma and metastatic carcinoma could produce very similar acinar and papillary structures.
  • In one patient, an open biopsy shortly before death showed only fibrous pleurisy, but malignant mesothelioma was found at necropsy. The authors noted that the two conditions can co-exist.
• The authors' conclusion: The authors concluded that papillary structures in the pleura with definite connective tissue cores are a positive indication for thoracoscopy or thoracotomy, although they may not by themselves be diagnostic of mesothelioma. In their view, atypical fibroblastic proliferation should be an additional indication for further investigation, and such changes could help avoid repeated, often unhelpful closed biopsies.
• Limitations the authors state:
  • The authors state that the changes seen in biopsies from patients later shown to have mesothelioma were sometimes insufficient for a definitive diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Biopsy, Mesothelioma, Pleurisy, Papillae, Mesothelial Cells, Mesothelium.

Related studies

• Interpretation of pleural biopsy specimens and aspirates with the immunoperoxidase technique — A. Herbert, P.J. Gallagher (1982)
• 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)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• An electrocautery pleural biopsy for the diagnosis of desmoplastic malignant mesothelioma during semirigid thoracoscopy — S. Sasada, K. Kawahara, et al. (2008)
• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Pleuroscopic punch biopsy using insulated-tip diathermic knife-2 for the diagnosis of desmoplastic malignant mesothelioma — K. Masai, S. Sasada, et al. (2013)

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