Pleural biopsy: a reliable
method for determining the diagnosis but not subtype in
mesothelioma
Pleural biopsy: a reliable method for determining the diagnosis but not
subtype in mesothelioma
Bueno R, Reblando J, Glickman J, Jaklitsch MT, Lukanich JM, Sugarbaker
DJ.
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
02115, USA
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.