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
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.
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
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.