Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma

Our plain-English summary of Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma, by C. Iadevaia, V. D'Agnano, R. Pagliaro, et al (Journal of Clinical Medicine, 2024).

The study

• Authors: C. Iadevaia, V. D'Agnano, R. Pagliaro, F. Nappi, R. Lucci, S. Massa, A. Bianco, F. Perrotta
• Journal: Journal of Clinical Medicine
• Published: 2024;13(9)
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/Objectives: Ultrasound (US) has been progressively spreading as the most useful technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. Malignant pleural mesothelioma (MPM) represents the most common malignant pleural tumour. Thoracoscopy represents the gold standard for diagnosis, although conditions hampering such diagnostic approach often coexist. The Objective was to determine whether ultrasound-guided percutaneous needle biopsy (US-PPNB) has a high diagnostic accuracy and represents a safe option for diagnosis of MPM. Methods: US-PPNB of pleural lesions suspected for MPM in patients admitted from January 2021 to June 2023 have been retrospectively analyzed. An 18-gauge semi-automatic spring-loaded biopsy system (Medax Velox 2®) was used by experienced pneumologists. The obtained specimens were histologically evaluated and defined as adequate or non-adequate for diagnosis according to whether the material was considered appropriate or not for immunohistochemistry (IHC) analysis. The primary objective of the study was the diagnostic yield for a tissue diagnosis. Results: US-PPNB was diagnostic of MPM in 15 out of 18 patients (sensitivity: 83.39%; specificity: 100%; PPV: 100%). Three patients with non-adequate US-PPNB underwent thoracoscopy for diagnosis. We found significant differences in terms of mean pleural lesion thickness between patients with adequate and not-adequate biopsy (15.4 mm (SD: 9.19 mm) and 3.77 mm (SD: 0.60 mm), p < 0.0010. In addition, a significant positive correlation has been observed between diagnostic accuracy and FDG-PET avidity value. Conclusions: US-PPNB performed by a pneumologist represents a valid procedure with a high diagnostic yield and accuracy for the diagnosis of MPM, and may be considered as an alternative option in patients who are not suitable for thoracoscopy.

In plain English

This was a retrospective study from one hospital, Monaldi Hospital in Naples, Italy. It looked back at 18 consecutive patients (11 men, 7 women) who, between January 2021 and June 2023, had an ultrasound-guided needle biopsy of the pleura (the lining around the lungs) because malignant pleural mesothelioma was suspected. Eleven of the 18 (61%) reported asbestos exposure. The article gave no further exposure details. The biopsy, done with an 18-gauge needle, gave enough tissue to diagnose mesothelioma in 15 of the 18 patients, and the authors reported a sensitivity of 83.39%. The other 3 patients had thoracoscopy, which also found mesothelioma. Mean lesion thickness was 15.4 mm in patients with adequate biopsies and 3.77 mm in those without. Lower PET scan uptake values were associated with worse diagnostic accuracy. Four patients had a pneumothorax (air leaking around the lung), which resolved within an average of 4 days with a small chest tube. No bleeding complications were recorded. The authors concluded the procedure had a high diagnostic yield, and they noted the study was small and retrospective.

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 single-center study of consecutive patients (diagnostic accuracy of a biopsy technique)
• Who was studied: 18 consecutive patients (11 males, 7 females) who had ultrasound-guided pleural biopsy for suspected malignant pleural mesothelioma at the Pneumologic Clinic L. Vanvitelli, Monaldi Hospital, Naples, Italy, between January 2021 and June 2023. The mean age at the time of procedure was 71.2. All had a final diagnosis of malignant pleural mesothelioma.
• Exposure: The study evaluated a diagnostic procedure, ultrasound-guided percutaneous pleural needle biopsy with an 18-gauge needle. It did not study asbestos exposure. It reported only that 11 of 18 patients (61%) reported asbestos exposure, with no fiber types, jobs or doses given.
• Main results:
  • In 15 of the 18 patients, the biopsy was diagnostic of malignant pleural mesothelioma (sensitivity 83.39%, specificity 100%, positive predictive value 100%).
  • Among adequate biopsies, 12 patients had epithelioid, 2 biphasic and 1 sarcomatoid mesothelioma.
  • In 3 patients the biopsy samples were not adequate. These 3 underwent thoracoscopy, which gave a final diagnosis of mesothelioma: 2 sarcomatoid and 1 epithelioid.
  • Mean pleural lesion thickness was 15.4 mm (SD 9.19 mm) in patients with adequate biopsies and 3.77 mm (SD 0.60 mm) in patients with not-adequate biopsies. Diagnostic accuracy was positively correlated with lesion thickness (p less than 0.001).
  • Diagnostic accuracy was positively correlated with the FDG-PET-CT avidity value (SUVmax) (p = 0.012), with lower SUVmax values associated with worse diagnostic accuracy.
  • Four patients (22% in Table 3) had complications including pneumothorax. These were treated with a small-bore chest tube and resolved within an average of 4 days (range 2 to 7). No hemorrhagic complications were recorded.
  • Pain: 14 patients scored less than 5 on the Numeric Rating Scale and 4 scored greater than 5. Mean duration of the procedure was 21 minutes (SD 4.67).
• The authors' conclusion: The authors concluded that 18-gauge ultrasound-guided percutaneous pleural needle biopsy performed by a pneumologist provides adequate samples for histological evaluation in patients with suspected malignant pleural mesothelioma, with a high diagnostic yield. In the abstract they added that it may be considered an alternative in patients not suitable for thoracoscopy.
• Limitations the authors state:
  • Retrospective design and small number of enrolled patients
  • The Doppler signal was not correlated with diagnostic accuracy because of poor image quality
  • Contrast-enhanced ultrasound was not used in the cohort

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Needle Biopsy, Pleural Mesothelioma, Fine-Needle Aspiration, Thoracoscopy, Biopsy, Immunohistochemistry.

Related studies

• Diagnostic ability and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy diagnosis for malignant pleural mesothelioma — Y. Zhang, J. Tang, et al. (2022)
• Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention — H. Zhang, Y. Guang, et al. (2020)
• Combined Ultrasound-Guided Thoracentesis, Percutaneous Pleural Biopsy, and Indwelling Pleural Catheter Insertion as the First Intervention in Patients With High Likelihood of Malignant Pleural Effusion — M.V. Brown, J. Solujic, et al. (2025)
• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Clinical value of CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions — H. Yu, C. Zhang, et al. (2020)
• Computed tomography-guided cutting needle pleural biopsy: Accuracy and complications — Y.Y. Cao, N. Fan, et al. (2015)

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