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Chest. 2001 Dec;120(6):1798-802.

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

Author information

1
Oxford Center for Respiratory Medicine, Churchill Hospital, Oxford, UK.

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.

PMID:
11742904
DOI:
10.1378/chest.120.6.1798
[Indexed for MEDLINE]

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