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


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.


CONCLUSIONS
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.
Adams
R F
RF
Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals, Old Rd, Headington, Oxford OX3 7LJ, England.
Gleeson
F V
FV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional