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

Chest. 2001;120:1798-1802 Received for publication November 2, 2000. Accepted for publication July 9, 2001. [Link]

Rosie F. Adams, BM BCh

Winifred Gray, MB BS; Robert J. O. Davies, DM and Fergus V. Gleeson, MB BS

* From the Oxford Center for Respiratory Medicine (Drs. Adams, Davies, and Gleeson), Churchill Hospital; and Department of Cellular Pathology (Dr. Gray), John Radcliffe Hospital, Oxford, UK.

Correspondence to: Fergus V. Gleeson, MB BS, Consultant Radiologist, Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals, Old Road, Headington, Oxford, OX3 7LJ, UK


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.

Keywords: biopsy, CT, image guidance, mesothelioma, ultrasound