title: Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist.
  
  
  METHODS
  Teaching hospital chest radiology department.
  
  
  METHODS
  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.
  
  
  METHODS
  Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients.
  
  
  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.
authors.affiliation: Oxford Center for Respiratory Medicine, Churchill Hospital, Oxford, UK.
authors.forename: R F
authors.initials: RF
authors.lastname: Adams
authors.forename: W
authors.initials: W
authors.lastname: Gray
authors.forename: R J
authors.initials: RJ
authors.lastname: Davies
authors.forename: F V
authors.initials: FV
authors.lastname: Gleeson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000473:pathology*; D008875:Middle Aged; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D014463:Ultrasonography / Q000295:instrumentation*
chemical_list: D014408:Biomarkers, Tumor