Role of percutaneous CT-guided biopsy in the characterisation of pleural diseases

Our plain-English summary of Role of percutaneous CT-guided biopsy in the characterisation of pleural diseases, by I. Pasha, A.K. Singh, Z. Hashim, et al (Lung India, 2023).

The study

• Authors: I. Pasha, A.K. Singh, Z. Hashim, A. Nath, Z. Neyaz, R. Mishra, V. Agrawal
• Journal: Lung India
• Published: 2023;40(6):514-520
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Computed tomography (CT)-guided biopsy is emerging as a preferred and safe method for obtaining tissue samples in pleural diseases.

Objective: This study aimed to evaluate the diagnostic yield and safety of percutaneous CT-guided biopsy in pleural diseases and to find CT findings predictive of malignant neoplastic pleural disease.

Material And Methods: This retrospective study included 77 patients with pleural disease who underwent CT-guided pleural biopsies from July 2013 to May 2020. All procedures were performed with a coaxial semi-automatic biopsy device. Histopathology was performed in all cases, and additional tests such as immunohistochemistry (IHC) or microbiological analysis were carried out depending on clinical suspicion. The correlation of CT findings with final diagnosis was performed by Chi-square, Fisher's exact test and logistic regression analysis.

Results: The overall technical success rate of CT-guided pleural biopsy was 100% with a diagnostic yield of 96.1%. No major complication was encountered, with minor complications encountered in the form of minimal pneumothorax and chest pain. Malignant pleural conditions constituted the largest group including metastatic adenocarcinoma as the most common (31.2%), followed by metastatic squamous cell carcinoma and mesothelioma. Tubercular pleural involvement was the second most common category (16.9%). The cartridge-based nucleic acid amplification test (CB-NAAT) assay had 90% sensitivity on pleural tissue in tubercular cases. CT features predictive of malignancy were irregular and nodular pleural thickening, mediastinal and diaphragmatic pleural involvement and mediastinal/chest wall invasion. There was a good correlation between higher pleural thicknesses with malignant outcome.

Conclusion: Percutaneous CT-guided biopsy is a safe method for obtaining pleural tissue samples with high diagnostic yield. CT findings provide clues, which favour malignant pleural involvement.

In plain English

This retrospective study, from a hospital radiology department in Lucknow, India, reviewed 77 patients with pleural disease who had CT-guided needle biopsies of the pleura between July 2013 and May 2020. The authors measured how often the biopsy gave a usable diagnosis, what complications occurred, and which CT scan features went with cancer. Tissue was obtained in all 77 patients, and the diagnostic yield was 96.1%. Two patients (2.5%) had a pneumothorax (air around the lung) and three (3.8%) had mild chest pain. The most common final diagnosis was metastatic adenocarcinoma (31.2%). There were five cases of malignant pleural mesothelioma, and 16.9% of cases were tuberculosis. Among 73 patients compared, these features were significantly associated with a cancer diagnosis: irregular or nodular thickening, thicker pleura, involvement of the mediastinal or diaphragmatic pleura, and invasion of the chest wall or mediastinum. The article did not study or report asbestos exposure. The authors concluded the biopsy was safe. They noted the study was 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 study of departmental biopsy records
• Who was studied: 77 patients with pleural disease (49 males, 28 females) who had CT-guided pleural biopsy in the Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, July 2013 to May 2020
• Exposure: No exposure was studied. This is a study of a diagnostic procedure (CT-guided pleural biopsy), and asbestos or other fiber exposure is not discussed.
• Main results:
  • Pleural tissue was obtained in all cases (technical success 100%).
  • Diagnostic yield of the biopsy was 96.1%. Conclusive or clinically meaningful results were obtained in 74 of 77 patients.
  • Minor complications: pneumothorax in two patients (2.5%) and mild chest pain in three patients (3.8%). No patient needed a chest tube, and no major complications occurred.
  • Metastatic adenocarcinoma was the most common final diagnosis (31.2%).
  • Five patients had malignant pleural mesothelioma.
  • 16.9% of cases were tuberculosis (13 patients).
  • Diffuse irregular and diffuse nodular thickening was significantly related to a malignant diagnosis: 36 of 48 malignant cases vs 5 of 25 non-neoplastic cases.
  • Greater maximum pleural thickness was significantly correlated with malignancy (P-value = 0.0041). The mean was 18 plus or minus 11.2 mm in the malignant group and 11.8 plus or minus 7 mm in the non-neoplastic group.
  • Involvement of the mediastinal or diaphragmatic pleura and invasion of the mediastinum or chest wall were also predictive of malignancy. Mediastinal pleura was involved in 39 of 48 malignant vs 4 of 25 non-neoplastic cases. Chest wall or mediastinal invasion was found in 24 malignant vs 0 non-neoplastic cases.
  • Pleural calcification was seen in three patients overall. It was not significantly associated with a malignant diagnosis: 1 malignant vs 1 non-neoplastic case, P = 0.634037.
  • In malignant cases, pleural fluid cytology was positive in 9 of 30 tested (sensitivity 30%).
  • In tuberculosis cases, the CB-NAAT test on pleural tissue was positive in 9 of 10 tested (90% sensitivity).
• The authors' conclusion: The authors concluded that percutaneous CT-guided needle biopsy is a minimally invasive and safe way to obtain adequate pleural tissue, with high technical success and diagnostic yield. They also concluded that certain CT features suggest malignant pleural disease.
• Limitations the authors state:
  • The study was retrospective and relied on the hospital information system.
  • Outside contrast-enhanced CT images were unavailable in many cases because patients had taken them back.
  • Bacterial culture is not routinely performed on pleural tissue at the institution.

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Histopathology, Immunohistochemistry, Pleural Biopsy, Pneumothorax, Adenocarcinoma, Squamous Cell Carcinoma, Mesothelioma.

Related studies

• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention — H. Zhang, Y. Guang, et al. (2020)
• Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma — C. Iadevaia, V. D'Agnano, et al. (2024)
• 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)
• Clinical value of CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions — H. Yu, C. Zhang, et al. (2020)
• A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma — B.T. Welch, P.W. Eiken, et al. (2017)

Browse more research in Lung India, or return to medical research.