Mesothelioma Biopsies: Ultrasound Guidance Beats CT

A new study concludes that ultrasound guided mesothelioma biopsies are safer and just as effective as CT guided biopsies. 

Italian researchers analyzed both types of guidance systems for collecting tissue samples from mesothelioma patients. They compared the diagnostic yield and safety of each method. 

It turns out that ionizing radiation is not necessary for successful mesothelioma biopsies. As long as the technician is experienced, ultrasound guidance may be the better choice. 

The Importance of Mesothelioma Biopsies

Pleural mesothelioma is a rare but highly aggressive kind of cancer. It grows on the membrane that surrounds the lungs. By the time patients experience symptoms of mesothelioma, the disease is often very advanced. 

Malignant mesothelioma can be tricky to diagnose. Mesothelioma biopsies are one of the most important elements of diagnosis. Imaging scans and blood tests may suggest mesothelioma. But, in most cases, a pathologist has to look at the cells under a microscope to know for sure. 

Imaging systems like CT and ultrasound allow doctors to perform mesothelioma biopsies without an operation. CT (computed tomography) uses ionizing radiation to create a 3D image of a tumor. Ultrasound bounces sound waves off the tumor to create an image. 

CT Versus Ultrasound Guidance

The new study is a meta-analysis of techniques for mesothelioma biopsies. A meta-analysis compiles data from several studies. Researchers from Italy’s Azienda Ospedaliero-Universitaria compiled data from 30 studies on CT or thoracic ultrasound (TUS) for diagnosing pleural lesions. 

The group found three times as many studies on TUS as CT. The amount of tissue (diagnostic yield) obtained with each technique was about the same. The difference was less than 10 percent. Both techniques were also safe. 

But there were some differences. As people got better at using the ultrasound technique, the diagnostic yield went up. There was no change in the diagnostic yield for CT guided mesothelioma biopsies over time. 

Another difference is that CT requires the patient to be in a machine. But ultrasound is mobile and can even be performed at the bedside. 

“Data show that CT- and TUS-guided biopsies in the diagnosis of pleural lesions are both excellent procedures, without meaningful differences in DYs and safety,” concludes lead author Federico Mei. “Considering that TUS is non-ionizing and easily performed at the bedside, it should be the preferred approach in presence of adequate skills.”

About 2,500 people receive a mesothelioma diagnosis each year in the US. 

Source:

Mei, F, et al, “Diagnostic Yield and Safety of Image-Guided Pleural Biopsy: A Systematic Review and Meta-Analysis”, December 29, 2020, Respiration, Online ahead of print, https://www.karger.com/Article/Abstract/511626