Percutaneous image-guided cutting-needle biopsy of the pleura in the presence of a suspected malignant effusion

Radiology. 2001 May;219(2):510-4. doi: 10.1148/radiology.219.2.r01ma07510.


Purpose: To evaluate the diagnostic accuracy of percutaneous image-guided cutting-needle biopsy of pleural thickening in the presence of a suspected malignant pleural effusion.

Materials and methods: Thirty-three adult patients with diffuse or focal pleural thickening (median, 1.0 cm; range, 0.2-6.0 cm), pleural effusion, and suspected pleural malignancy underwent percutaneous image-guided cutting-needle biopsy. Biopsy guidance was performed with computed tomography in 24 patients and ultrasonography in nine patients. A final diagnosis of benign or malignant disease was established with radiologic and clinical follow-up findings and with other histologic or cytologic findings, when available.

Results: A correct histologic diagnosis of malignant disease was made in 21 of 24 patients (sensitivity, 88%; specificity, 100%), including 13 of 14 patients with mesothelioma (sensitivity, 93%). A correct histologic diagnosis of benign pleural disease was made in nine patients. Positive and negative predictive values for malignant disease were 100% and 75%, respectively. The overall accuracy was 91%. Complications comprised a chest wall hematoma in one patient.

Conclusion: Image-guided percutaneous cutting-needle biopsy of pleural thickening in the presence of a pleural effusion is a safe procedure, with an overall accuracy of 91% in the diagnosis of malignancy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pleura / pathology*
  • Pleural Effusion, Malignant / diagnosis*
  • Pleural Effusion, Malignant / diagnostic imaging
  • Predictive Value of Tests
  • Radiography, Interventional*
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Ultrasonography, Interventional