Skip to main content

A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma



Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma.

Materials and Methods

Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)].


Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract.


Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

This is a preview of subscription content, access via your institution.


  1. 1.

    Armato SG 3rd, et al. Imaging in pleural mesothelioma: a review of the 11th international conference of the international mesothelioma interest group. Lung Cancer. 2013;82(2):190–6.

    Article  PubMed  Google Scholar 

  2. 2.

    Miller BH, et al. From the archives of the AFIP. Malignant pleural mesothelioma: radiologic–pathologic correlation. Radiographics. 1996;16(3):613–44.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Porpodis K, et al. Malignant pleural mesothelioma: current and future perspectives. J Thorac Dis. 2013;5(Suppl 4):S397–406.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Seely JM, et al. Malignant pleural mesothelioma: computed tomography and correlation with histology. Eur J Radiol. 2009;70(3):485–91.

    Article  PubMed  Google Scholar 

  5. 5.

    Agarwal PP, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiol. 2006;241(2):589–94.

    Article  Google Scholar 

  6. 6.

    Boutin C, Astoul P, Seitz B. The role of thoracoscopy in the evaluation and management of pleural effusions. Lung. 1990;168(Suppl):1113–21.

    Article  PubMed  Google Scholar 

  7. 7.

    Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med. 1991;114(4):271–6.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Zahid I, et al. What is the best way to diagnose and stage malignant pleural mesothelioma? Interact CardioVasc Thorac Surg. 2011;12(2):254–9.

    Article  PubMed  Google Scholar 

  9. 9.

    Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest. 1995;108(3):754–8.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Adams RF, et al. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest. 2001;120(6):1798–802.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet. 2003;361(9366):1326–30.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Metintas M, et al. CT-guided pleural needle biopsy in the diagnosis of malignant mesothelioma. J Comput Assist Tomogr. 1995;19(3):370–4.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Scott EM, et al. Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy. Radiology. 1995;194(3):867–70.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Atwell TD, et al. Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. AJR Am J Roentgenol. 2010;194(3):784–9.

    Article  PubMed  Google Scholar 

  15. 15.

    Atwell TD, et al. The timing and presentation of major hemorrhage after 18,947 image-guided percutaneous biopsies. AJR Am J Roentgenol. 2015;205(1):190–5.

    Article  PubMed  Google Scholar 

  16. 16.

    Olson MC, et al. Safety and accuracy of percutaneous image-guided core biopsy of the spleen. AJR Am J Roentgenol. 2016;206(3):655–9.

    Article  PubMed  Google Scholar 

  17. 17.

    National Cancer Institute. Common terminology criteria for adverse events (CTCAE) version 4.0; 2009.

  18. 18.

    Attanoos RL, Gibbs AR. The comparative accuracy of different pleural biopsy techniques in the diagnosis of malignant mesothelioma. Histopathology. 2008;53(3):340–4.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Heilo A, Stenwig AE, Solheim OP. Malignant pleural mesothelioma: US-guided histologic core-needle biopsy. Radiology. 1999;211(3):657–9.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Metintas M, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest. 2010;137(6):1362–8.

    Article  PubMed  Google Scholar 

  21. 21.

    Metintas M, et al. CT scan-guided Abrams’ needle pleural biopsy versus ultrasound-assisted cutting needle pleural biopsy for diagnosis in patients with pleural effusion: a randomized controlled trial. Respiration. 2016;91(2):156–63.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Bydder S, et al. A randomised trial of single-dose radiotherapy to prevent procedure tract metastasis by malignant mesothelioma. Br J Cancer. 2004;91(1):9–10.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Clive AO, et al. Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial. Lancet Oncol. 2016;17(8):1094–104.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Davies HE, Musk AW, Lee YC. Prophylactic radiotherapy for pleural puncture sites in mesothelioma: the controversy continues. Curr Opin Pulm Med. 2008;14(4):326–30.

    Article  PubMed  Google Scholar 

  25. 25.

    De Ruysscher D, Slotman B. Treatment of intervention sites of malignant pleural mesothelioma with radiotherapy: a Dutch-Belgian survey. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2003;68(3):299–302.

    Article  Google Scholar 

  26. 26.

    Nagendran M, et al. Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? Interact CardioVasc Thorac Surg. 2011;13(1):66–9.

    Article  PubMed  Google Scholar 

  27. 27.

    O’Rourke N, et al. A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2007;84(1):18–22.

    Article  Google Scholar 

  28. 28.

    West SD, Foord T, Davies RJ. Needle-track metastases and prophylactic radiotherapy for mesothelioma. Respir Med. 2006;100(6):1037–40.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to B. T. Welch.

Ethics declarations

Conflicts of interest

All authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Welch, B.T., Eiken, P.W., Atwell, T.D. et al. A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma. Cardiovasc Intervent Radiol 40, 860–863 (2017).

Download citation


  • Percutaneous image guided biopsy
  • Mesothelioma
  • Thoracic intervention