Percutaneous image-guided cutting-needle biopsy of the pleura in the presence of a suspected malignant effusion

PURPOSE: To evaluate the diagnostic accuracy of percutaneous image-guided c utting-needle biopsy of pleural thickening in the presence of a suspected m alignant pleural effusion. MATERIALS AND METHODS: Thirty-three adult patients with diffuse or fetal 1. 0 cm; range, 0.2-.0 cm), pleural effusion, and pleural thickening (median, suspected pleural malignancy underwent percutaneous image-guided cutting-ne edle biopsy. Biopsy guidance was performed with computed tomography in 24 p atients and ultrasonography in nine patients, A final diagnosis of benign o r 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 p atients with mesothelioma (sensitivity, 93%). A correct histologic diagnosi s of benign pleural disease Was made in nine patients. Positive and negativ e 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 thick ening in the presence of a pleural effusion is a safe procedure, with an ov erall accuracy of 91% in the diagnosis of malignancy.