Mesothelioma patients who are not good candidates for thoracoscopy can still get a definitive diagnosis with a procedure called cutting-needle pleural biopsy. A team of Oxford-based scientists compared the two procedures to determine whether ultrasound-guided cutting needle biopsy could produce enough tissue to diagnose mesothelioma.
Mesothelioma, an asbestos-linked malignancy that starts on the membrane around the lungs, can be difficult to diagnose. At the same time, because so many patients do not develop symptoms until the disease is in its later stages, rapid and accurate diagnosis is critical.
Although patients suspected of having mesothelioma may undergo imaging tests, blood tests for tell-tale biomarkers, and pleural fluid analysis, tissue biopsy and examination of the cells remains the only way to obtain a definitive mesothelioma diagnosis.
Thoracoscopy is one way to obtain a tissue sample. It involves inserting a camera and medical instruments through incisions in the chest wall. But very frail mesothelioma patients, those with excess fluid around the lungs (effusions), or those whose lung has adhered to the chest wall may not be candidates for thoracoscopy. In these cases, the new study suggests that ultrasound-guided cutting-needle biopsy, performed by a physician, is a safe and reliable alternative.
In the study published in the journal Chest, researchers performed a retrospective review of 50 ultrasound-guided needle biopsies in suspected cases of mesothelioma. Forty-seven of those cases obtained enough tissue to make a diagnosis. Notably, 13 of the cases reviewed were performed after a failed thoracoscopy. Thirty-four of the patients who underwent the cutting-needle biopsy procedure turned out not to have mesothelioma, while 13 cases were confirmed. There was only one false-negative result.
“Within this population, physician-based ultrasound-guided cutting-needle pleural biopsy obtains pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy,” concludes lead author Rob Halifax, MSc, of the Oxford Centre for Respiratory Medicine. Great Britain has one of the highest rates of mesothelioma and other asbestos-related pleural diseases in the world and is the site of many ongoing mesothelioma research studies.
Halifax, RJ et al, “Physician-based ultrasound-guided biopsy for diagnosing pleural disease”, May 15, 2014, Chest, Epub ahead of print