Percutaneous Image-Guided Cutting Needle Biopsy of the Pleura in the Diagnosis of Malignant Mesothelioma

• Published in: Chest Vol. 120; no. 6; pp. 1798 - 1802
• Main Authors: Adams, Rosie F., Gray, Winifred, Davies, Robert J.O., Gleeson, Fergus V.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.12.2001; American College of Chest Physicians
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers, Tumor - analysis; Biopsy; Biopsy, Needle - instrumentation; Cellular biology; Equipment Design; Female; Histology; Humans; image guidance; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Mesothelioma; Mesothelioma - pathology; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; Pleura - pathology; Pleural effusion; Pleural Neoplasms - pathology; Predictive Value of Tests; Respiratory system; Retrospective Studies; Surgery, Computer-Assisted - instrumentation; Teaching hospitals; Tomography, X-Ray Computed - instrumentation; Ultrasonic imaging; Ultrasonography - instrumentation; ultrasound; United States > US; Western Europe; CT; CNB; image guidance; biopsy; EMA; FNA; mesothelioma; ultrasound; Human; Immunohistochemistry; Respiratory disease; Exploration; Malignant tumor; Guidance; Pathology; Malignant mesothelioma; Biopsy; Needle; Pleural disease; Medical imagery; Diagnosis; Technique; Pleura
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.120.6.1798

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. Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist. Teaching hospital chest radiology department. 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. Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients. 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 ≤ 5 mm underwent biopsy, and all specimens were diagnostic for mesothelioma. Image-guided percutaneous CNB of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma. Pleural thickening of ≤ 5 mm may be successfully sampled.