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(Radiology. 2001;219:510-514.)
© RSNA, 2001

Vascular and Interventional Radiology

Percutaneous Image-guided Cutting-Needle Biopsy of the Pleura in the Presence of a Suspected Malignant Effusion1

Rosie F. Adams, MA, BM BCh and Fergus V. Gleeson, MB BS

1 From the Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals, Old Rd, Headington, Oxford OX3 7LJ, England. From the 2000 RSNA scientific assembly. Received April 17, 2000; revision requested June 7; revision received August 22; accepted October 2. Address correspondence to F.V.G. (e-mail: fergus.gleeson@radiology.oxford.ac.uk).

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

MATERIALS AND 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.

CONCLUSION: 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.

Index terms: Computed tomography (CT), guidance, 66.1263 • Mesothelioma, 66.317 • Pleura, biopsy, 66.1263 • Pleura, fluid, 66.76 • Pleura, neoplasms, 66.317, 66.33 • Ultrasound (US), guidance, 66.12985




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