Image-guided pleural biopsy
Wednesday, June 4th, 2008.
Current Opinion in Pulmonary Medicine. 14(4):331-336, July 2008. [Link]
Rahman NM, Gleeson FV.
Oxford Centre for Respiratory Medicine and University of Oxford, Oxford Radcliffe Hospital, UK.
Abstract
Purpose of review: Pleural diseases are a common and increasing clinical problem. Establishing accurate diagnosis is an essential step in management of these patients, and approximately 40% of pleural effusions will remain undiagnosed after initial diagnostic thoracocentesis. Obtaining pleural tissue (by blind, image-guided or thoracoscopic pleural biopsy) is therefore a key procedure. Recent evidence provides important information on the relative value of each of these techniques.
Recent findings: For the diagnosis of malignant pleural disease, both thoracoscopic and image-guided biopsy have a far higher diagnostic yield than blind pleural biopsy. Cutting needle biopsies have a higher diagnostic yield in malignancy (and especially mesothelioma) compared with fine needle aspiration. The complication rate of image-guided biopsy is low. Rates of biopsy site tract invasion by mesothelioma may be lower using smaller biopsy ports, as used for image-guided pleural biopsy.
Summary: Blind pleural biopsy should no longer be conducted for the study of malignant pleural disease if facilities for other techniques are available. Image-guided and thoracoscopic biopsies have similarly high diagnostic rates, and are complementary techniques used in different clinical situations. Further studies assessing biopsy tract site invasion from mesothelioma with different biopsy techniques are required.
Glossary
- needle aspiration
- a type of needle biopsy. Removal of fluid from a cyst or cells from a tumor. In this procedure, a needle is used to reach the cyst or tumor, and with suction, draw up (aspirate) samples for examination under a microscope. If the needle is thin, the procedure is called a fine needle aspiration or FNA. (See also biopsy.)
- fine needle aspiration
- see needle aspiration.
- diagnosis
- identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.
- biopsy
- (buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.
- tissue
- a collection of cells, united to perform a particular function.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
