Diagnostic ability and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy diagnosis for malignant pleural mesothelioma

Our plain-English summary of Diagnostic ability and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy diagnosis for malignant pleural mesothelioma, by Y. Zhang, J. Tang, X. Zhou, et al (Frontiers in Surgery, 2022).

The study

• Authors: Y. Zhang, J. Tang, X. Zhou, W. Chen, S. Zhang, Y. Li, D. Zhou, L. He, Q. Tang
• Journal: Frontiers in Surgery
• Published: 2022;9:1022505
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a highly invasive malignant tumor. Ultrasound guidance has the advantages of real-time, convenience and nonradiative. We sought to identify diagnostic value and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy (US-PPNB) for MPM.

Methods: Patients who underwent US-PPNB between March 2014 and March 2020 and were finally diagnosed with MPM were retrospectively analyzed. We retrospectively analyzed the US-PPNBs pathological results of all patients clinically confirmed as MPM, and divided US-PPNBs into correctly and incorrectly diagnosed groups. Patient, thoracic, and biopsy variables that affected diagnostic accuracy were assessed. All variables significant on univariate analyses were subjected to multivariate logistic regression to identify significant predictors of diagnostic accuracy. We derived cutoffs for all significant continuous variables and used the Mantel-Haenszel test to determine whether the diagnostic accuracy of US-PPNB for MPM increased with pleural thickness.

Results: In total, 49 patients with clinically confirmed MPM underwent US-PPNB; 37 diagnoses were correct and 12 were incorrect (accuracy = 75.5%). The pleura was significantly thicker in the correctly diagnosed group (p < 0.001). The pleural thickness cutoff was 4.15 mm and diagnostic accuracy increased with pleural thickness grade (p for trend <0.05). The diagnostic accuracy was significantly higher when 16-G rather than 18-G biopsy needles were used (p < 0.05). Multivariate logistic regression showed that pleural thickness (odds ratio: 17.2, 95% confidence interval: 2.8-104.1, p = 0.002) and needle size (odds ratio: 6.8, 95% confidence interval: 1.0-44.5, p = 0.044) independently predicted diagnostic accuracy.

Conclusion: US-PPNB afforded high MPM diagnostic accuracy, and pleural thickness and needle size significantly impacted accuracy.

© 2022 Zhang, Tang, Zhou, Chen, Zhang, Li, Zhou, He and Tang.

In plain English

This retrospective study, from the First Affiliated Hospital of Guangzhou Medical University in China, looked at how often an ultrasound-guided needle biopsy of the pleura (the lining around the lungs) correctly identified malignant pleural mesothelioma. It included 49 patients who had the biopsy between March 2014 and March 2020 and were diagnosed with this cancer. The study did not examine asbestos exposure. The first biopsy gave the correct diagnosis in 37 of the 49 patients (75.5%). Correct diagnoses were more common when the pleura at the biopsy site was thicker. Accuracy was 47.4% when it was under 4.15 mm and 93.3% when it was 4.15 mm or more. Accuracy was also higher with the 16-gauge needle (20 of 22 correct) than with the 18-gauge needle (17 of 27 correct). In the combined analysis, pleural thickness (odds ratio 17.2, 95% confidence interval 2.8 to 104.1) and needle size (odds ratio 6.8, 95% confidence interval 1.0 to 44.5) each independently predicted accuracy. The authors concluded the biopsy had high accuracy. They named their small sample and retrospective design as limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of diagnostic accuracy at a single hospital
• Who was studied: 49 patients with clinically confirmed malignant pleural mesothelioma who had ultrasound-guided percutaneous pleural needle biopsy at the First Affiliated Hospital of Guangzhou Medical University, China, between March 2014 and March 2020. The group was 29 males and 20 females, with a mean age of 61.4 years (range 22 to 85). Subtypes were 38 epithelioid, 6 sarcomatoid, 4 biphasic and 1 not subclassified. By TNM stage, 11 were stage I, 8 stage III and 30 stage IV.
• Exposure: No asbestos exposure was assessed. The study examined a diagnostic procedure: ultrasound-guided pleural biopsy with an 18- or 16-gauge automated cutting needle. The factors examined were age, sex, TNM stage, pleural thickness, pleural effusion, use of contrast agent, number of punctures, needle size and side of the chest.
• Main results:
  • Of the 49 patients, the first biopsy gave a correct diagnosis in 37 and an incorrect one in 12 (accuracy 75.5%).
  • Average pleural thickness was 15.0 ± 17.0 mm in the 37 correctly diagnosed cases and 3.0 ± 2.3 mm in the 12 incorrectly diagnosed cases (p less than 0.001).
  • The best pleural thickness cutoff was 4.15 mm, with a sensitivity of 75.7%, specificity of 83.3% and AUC of 0.86.
  • Diagnostic accuracy was 47.4% for thin pleurae (under 4.15 mm) and 93.3% for thick pleurae (4.15 mm or more).
  • Accuracy increased with pleural thickness grade (grade 1 under 4.15 mm; grade 2 4.15 to 10 mm; grade 3 over 10 mm), p for trend less than 0.05.
  • With the 16-gauge needle, 22 patients were biopsied: 20 were correctly and 2 incorrectly diagnosed. With the 18-gauge needle, 27 patients were biopsied: 17 correct and 10 incorrect. Accuracy with the 16-gauge needle was significantly higher (p less than 0.05; Table 2 gives p = 0.043).
  • In multivariate logistic regression, pleural thickness (odds ratio 17.2, 95% confidence interval 2.8 to 104.1, p = 0.002) independently predicted diagnostic accuracy.
  • In multivariate logistic regression, needle size (odds ratio 6.8, 95% confidence interval 1.0 to 44.5, p = 0.044) independently predicted diagnostic accuracy.
  • The correctly and incorrectly diagnosed groups did not differ significantly in age, sex, pleural effusion status, use of contrast agent or number of punctures.
  • For 'dry' mesothelioma (no effusion or effusion under 10 mm), accuracy was 88.9% (16 of 18), with an average pleural thickness of 24.6 mm.
  • Two complications occurred: one slight pleural reaction (chest tightness and dizziness) and one minor bleed inside the chest. Both responded to symptomatic treatment.
• The authors' conclusion: The authors concluded that ultrasound-guided percutaneous pleural needle biopsy has high diagnostic accuracy for malignant pleural mesothelioma, and that pleural thickness and cutting-needle size significantly affect accuracy.
• Limitations the authors state:
  • The retrospective design may create a risk of selection bias.
  • The sample was small.
  • Only a few patients had surgery, so biopsy specimens could not be compared with surgical specimens.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Needle Biopsy, Pleural Mesothelioma, Biopsy, Pleural Thickening, Pleura, Odds Ratio, confidence interval.

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