HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Raphael Bueno Michael T. Jaklitsch Jeanne M. Lukanich David J. Sugarbaker Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bueno, R. Articles by Sugarbaker, D. J. Search for Related Content PubMed PubMed Citation Articles by Bueno, R. Articles by Sugarbaker, D. J. Related Collections Pleura

Ann Thorac Surg 2004;78:1774-1776
© 2004 The Society of Thoracic Surgeons

---

Original article: general thoracic

Pleural Biopsy: A Reliable Method for Determining the Diagnosis But Not Subtype in Mesothelioma

^a Division of Thoracic Surgery, Boston, MA, USA
^b Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA

Accepted for publication May 4, 2004.

^* Address reprint requests to Dr Bueno, Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
rbueno{at}partners.org

BACKGROUND: Survival after tri-modality therapy with extrapleural pneumonectomy (EPP) and postoperative chemoradiotherapy is longer for patients with epithelial MPM versus mixed or sarcomatoid subtypes, leading some to decline aggressive therapy for patients with nonepithelial histology. However, pathologic diagnosis of malignant pleural mesothelioma (MPM) and subclassification into one of the three histologic subtypes (epithelial, mixed, sarcomatoid) can be challenging. Pleural biopsy has been proposed as the diagnostic gold standard. We investigated the accuracy of open pleural biopsy for diagnosis and subtype identification in MPM.

METHODS: Patients with suspected MPM routinely undergo open pleural biopsy to establish diagnosis. Those diagnosed definitively by pleural biopsy or cytology are offered pleurectomy or EPP dependent on stage and cardiorespiratory status. We reviewed medical records for all patients undergoing EPP at our institution, comparing tissue and subtype diagnosis at initial diagnostic biopsy versus definitive resection.

RESULTS: Between 1988 and 2000, 305 of 332 consecutive patients undergoing EPP had MPM. One patient diagnosed with MPM at pleural biopsy was misclassified. Subtype analysis at pleural biopsy proved correct in 80% (226/282). Most patients (174/192) with epithelial subtype at final diagnosis were diagnosed correctly at pleural biopsy. However, 44% (45/103) with pathologic diagnosis of nonepithelial subtype at resection were initially misdiagnosed with the epithelial subtype. The sensitivity of pleural biopsy for epithelial MPM was 97% with a specificity of 56%.

CONCLUSIONS: Open pleural biopsy is accurate and should be considered the gold standard diagnostic method for MPM. It is less sensitive for determining histologic subclass, particularly with nonepithelial subtypes.

This article has been cited by other articles:

				K J Butnor My approach to the diagnosis of mesothelial lesions. J. Clin. Pathol., June 1, 2006; 59(6): 564 - 574. [Abstract] [Full Text] [PDF]

				F. Lopez-Rios, S. Chuai, R. Flores, S. Shimizu, T. Ohno, K. Wakahara, P. B. Illei, S. Hussain, L. Krug, M. F. Zakowski, et al. Global Gene Expression Profiling of Pleural Mesotheliomas: Overexpression of Aurora Kinases and P16/CDKN2A Deletion as Prognostic Factors and Critical Evaluation of Microarray-Based Prognostic Prediction. Cancer Res., March 15, 2006; 66(6): 2970 - 2979. [Abstract] [Full Text] [PDF]