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

doi:10.1378/chest.120.6.1798

Chest

Volume 120, Issue 6, December 2001, Pages 1798-1802

https://doi.org/10.1378/chest.120.6.1798 Get rights and content

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 ≤ 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 ≤ 5 mm may be successfully sampled.

Section snippets

Materials and Methods

We identified 53 consecutive patients with pleural thickening demonstrated on contrast-enhanced CT, who had been referred for image-guided pleural CNB. The patients were identified from radiology department biopsy records. The biopsies were performed over a 7-year period at a single teaching hospital with a referral population of 550,000. The case notes and radiology and histology reports of this group of patients were reviewed to ascertain the final diagnosis of each patient. Twenty patients

Results

The results are summarized in Table 1. There were 19 men and 2 women (age range, 47 to 84 years; median, 65 years). The mode of biopsy guidance was by CT in 15 patients and by ultrasound in 6 patients. The size of automated cutting needle used was 18 gauge in 16 patients, 14 gauge in 3 patients, and both 18 gauge and 14 gauge in 2 patients. There were a total of 31 cutting needle passes and 20 FNA passes, giving an average of 2.4 passes per patient (1.5 cutting needle passes per patient).

Discussion

Around the world, the incidence of malignant mesothelioma has either risen to a peak or will continue to rise for the next few decades, depending on the pattern of asbestos use in that region. Although there is no current curative treatment for malignant mesothelioma, it is an important diagnosis to make for prognostic reasons and palliative treatment.

Both pleural fluid cytology and nonguided hook needle biopsy have low sensitivities for diagnosing malignant mesothelioma, and require the

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Citation Excerpt :
They are typically used with CT or ultrasound guidance. The reported sensitivity of these percutaneous needle biopsies for MPE is higher than that of traditional closed pleural biopsy in the range of 83–88% [64–67]. Even with newer needles and imaging guidance the sensitivity of closed pleural biopsy for MPE remains less than that of thoracoscopy.
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Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020–2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30–31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.

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Chest

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

Study objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Mayo Clin Proc

Chest

Chest

Chest

Chest

Chest

Analysis of current trends in United States mesothelioma incidence

Am J Epidemiol

The European mesothelioma epidemic

Br J Cancer

Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients

J Clin Oncol

Thoracoscopy in malignant mesothelioma: a prospective study of 188 consecutive patients; Part 1. Diagnosis

Cancer

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