The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura

Our plain-English summary of The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura, by H.D. Beauchamp, N.K. Kundra, R. Aranson, et al (Chest, 1992).

The study

• Authors: H.D. Beauchamp, N.K. Kundra, R. Aranson, F. Chong, K.F. MacDonnell
• Journal: Chest
• Published: 1992;102(4):1110-2
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma of the pleura is a disease that requires a biopsy procedure for a definitive diagnosis. In the past, closed pleural needle biopsy (CPNB) has given poor yields due to the small amount of tissue obtained, and the patient has subsequently been subjected to a diagnostic thoracotomy. In recent years, the availability of more accurate histopathologic tests have enabled the pathologist to make a diagnosis more easily on samples obtained at CPNB. In this retrospective study of 20 consecutive cases of malignant mesothelioma of the pleura diagnosed between 1980 and 1990, we found that a blind CPNB was diagnostic in five of seven procedures and CT-guided CPNB was diagnostic in five of six procedures. An open pleural biopsy (OPB) was diagnostic in ten of ten procedures performed. There were no complications associated with any of the CPNB procedures. We conclude that CPNB is a safe and effective manner of diagnosing malignant mesothelioma of the pleura, and should be attempted prior to OPB.

In plain English

This was a retrospective review of hospital records for 20 consecutive patients diagnosed with malignant mesothelioma of the pleura at St. Elizabeth's Hospital and Quigley Memorial Hospital in Boston between 1980 and 1990. The study looked at how well different biopsy methods produced a diagnosis. It did not report the patients' asbestos exposure. The patients were 19 men and one woman, aged 54 to 82. A blind closed pleural needle biopsy (done without imaging guidance, using an Abram's needle) gave a diagnosis in five of seven patients (71 percent). A CT-guided needle biopsy gave a diagnosis in five of six patients (83 percent), including one patient whose earlier blind biopsy had not. Altogether, 10 of 13 needle biopsies in 12 patients (77 percent) were diagnostic. Open pleural biopsy, a surgical procedure, gave a diagnosis in all ten patients who had it. There were no complications from the needle biopsies. The authors suggested the needle biopsy yields probably reflected newer laboratory tests. They concluded that closed needle biopsy is safe and effective and should be tried before open biopsy.

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 consecutive cases (case series) comparing diagnostic biopsy methods
• Who was studied: 20 consecutive patients (19 men, 1 woman, aged 54 to 82, mean 67.5 years) with malignant mesothelioma of the pleura diagnosed at St. Elizabeth's Hospital and Quigley Memorial Hospital, Boston, 1980 to 1990. Tumor types were 10 epithelial, 4 sarcomatous and 6 mixed.
• Exposure: The article does not report the patients' asbestos exposure. The study compared biopsy methods: blind closed pleural needle biopsy with an Abram's needle, CT-guided closed pleural needle biopsy with a Greene needle, and open pleural biopsy.
• Main results:
  • Blind closed pleural needle biopsy was diagnostic in 5 of 7 patients (71 percent)
  • CT-guided closed pleural needle biopsy was diagnostic in 5 of 6 patients (83 percent). One of these six had previously had a negative blind biopsy.
  • Overall, 10 of 13 closed needle biopsies performed in 12 patients (77 percent) were diagnostic
  • Open pleural biopsy was diagnostic in all 10 patients who had it
  • No complications were associated with any closed needle biopsy
  • All 16 specimens tested with keratin antibodies reacted positively. All 17 specimens tested with CEA antibodies reacted negatively.
• The authors' conclusion: The authors concluded that closed pleural needle biopsy is a safe and effective way to diagnose malignant mesothelioma of the pleura and should be attempted before open pleural biopsy. They suggested the higher yield probably reflected newer, more accurate diagnostic tests.

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, Mesothelioma, Pleura, Biopsy, Thoracotomy, Pleural Biopsy.

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)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Cytopathology of malignant mesothelioma of the pleura in fine-needle aspiration biopsy — G.K. Nguyen, M.R. Akin, et al. (1999)
• 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)
• Pulmonary needle aspiration biopsy in the diagnosis of Pancoast tumors — W.J. Walls, J.R. Thornbury, et al. (1974)
• Malignant pleural mesothelioma: US-guided histologic core-needle biopsy — A. Heilo, A.E. Stenwig, et al. (1999)

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