Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma

Chest. 2001 Dec;120(6):1798-802. doi: 10.1378/chest.120.6.1798.


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 < or = 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 < or = 5 mm may be successfully sampled.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / analysis
  • Biopsy, Needle / instrumentation*
  • Equipment Design
  • Female
  • Humans
  • Male
  • Mesothelioma / pathology*
  • Middle Aged
  • Pleura / pathology
  • Pleural Neoplasms / pathology*
  • Predictive Value of Tests
  • Retrospective Studies
  • Surgery, Computer-Assisted / instrumentation*
  • Tomography, X-Ray Computed / instrumentation*
  • Ultrasonography / instrumentation*


  • Biomarkers, Tumor