Image-Guided Needle Biopsies Could Replace Invasive Diagnostic Procedures for Pleural Mesothelioma, Study Suggests

Image-Guided Needle Biopsies Could Replace Invasive Diagnostic Procedures for Pleural Mesothelioma, Study Suggests

Percutaneous image-guided biopsies are very sensitive in detecting malignant pleural mesothelioma (MPM) with few complications, and may decrease the need for surgical biopsies, according to a new study.

The study, “A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma,” appeared in the journal CardioVascular and Interventional Radiology.

MPM is usually diagnosed with thoracoscopy or open surgical biopsies, but these methods are invasive and expensive. Also, MPM may spread to surgical sites, leading to painful chest wall metastases.

Researchers sought to evaluate the sensitivity of percutaneous image-guided biopsy in diagnosing MPM and the rates of tract seeding (cancer spread associated with the procedure). This procedure usually relies on the insertion of an automated needle in the tumor site under the guidance of ultrasounds.

In a retrospective analysis, a Mayo Clinic team identified 32 MPM patients who underwent image-guided needle biopsy between 2002 and 2006. A total of 33 image-guided biopsy procedures were carried out. Researchers also collected data on the patients, procedures and disease characteristics.

The analysis indicated that percutaneous image-guided biopsy correctly diagnosed 81 of every 100 cases of MPM, with no clinically significant complications  reported. The image-guided procedure caused no pneumothorax complications, and patients did not need hospitalization or chest tube placement after the biopsy procedure. Nor were there reports of patients with tumor seeding of the biopsy tract during the 11-month follow-up period.

“Our study demonstrates percutaneous image-guided biopsy for MPM is associated with extremely low rates of complication, negligible risk of tract seeding, and acceptable sensitivity,” the researchers wrote. “[P]ercutaneous [image-guided biopsy] may be a reasonable, less costly, and less invasive first step to obtain histologic confirmation of MPM and obviate the need for further intervention in the majority of patients.”

The researchers noted that their study had limitations, namely its retrospective design occurring over a long period (15 years), and the differences in the number and experience of physicians conducting the procedure. There were also differences regarding biopsy protocol used, choice of image guidance, and device size.

However, its results show that MPM may be diagnosed using percutaneous image-guided biopsy with high sensitivity and that this method should be considered a first-line option for diagnosis of MPM.

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