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Updated: Jul 3, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
The comparative accuracy of different pleural biopsy techniques in the diagnosis of malignant mesothelioma
1Department of Histopathology, Cardiff and Vale NHS Trust, Llandough Hospital, Cardiff, UK. richard.attanoos@cardiffandvale.wales.nhs.uk
Aims:
To evaluate the diagnostic accuracy of closed and open pleural biopsies in diagnosing malignant pleural mesothelioma.
Methods And Results:
The autopsy study group comprised 45 malignant mesotheliomas. All prior pleural biopsy investigations were reviewed. Forty-one of 45 (91%) had had an antemortem diagnosis of malignant mesothelioma. In these 41 cases, 57 prior diagnostic pleural biopsies had been performed [36 closed needle biopsies: 31 blind; five computed tomography (CT)-guided and 21 open pleural biopsies]. For definitive diagnosis open pleural biopsy yielded a sensitivity of 95% and specificity of 100%. For definitive diagnosis closed blind pleural biopsies yielded a sensitivity of 16% and specificity of 94%. Thirty-two per cent of 'blind' biopsies were inadequate. CT-guided pleural biopsies yielded a definitive diagnostic accuracy of 100% (5/5). Biopsy specimen size was important in obtaining a positive definitive diagnosis. Diagnosis was attained in 75% of specimens >10 mm in size compared with 8% <10 mm in size.
Conclusions:
Overall, all procedures had utility but definitive diagnostic accuracy for 'blind' closed pleural biopsy was low (16%), dependent on biopsy specimen size and tumour subtype. Sarcomatoid subtype malignant mesothelioma yielded the lowest diagnostic accuracy. For all subtypes of malignant mesothelioma, open pleural biopsy produced the highest diagnostic accuracy (100% sensitivity, 95% specificity).
Insights
Open pleural biopsy offers superior diagnostic accuracy for malignant pleural mesothelioma compared to closed biopsies. Specimen size significantly impacts diagnosis, with larger samples yielding better results.
Area of Science:
- Thoracic oncology
- Diagnostic pathology
- Pulmonology
Background:
- Malignant pleural mesothelioma diagnosis relies on accurate tissue sampling.
- Evaluating the efficacy of different pleural biopsy techniques is crucial for patient management.
Purpose of the Study:
- To compare the diagnostic accuracy of closed (blind and CT-guided) and open pleural biopsies for malignant pleural mesothelioma.
Main Methods:
- Retrospective review of 45 autopsy cases of malignant pleural mesothelioma.
- Analysis of 57 prior pleural biopsy procedures, including closed needle biopsies (blind and CT-guided) and open pleural biopsies.
- Assessment of biopsy specimen size and subtype impact on diagnostic yield.
Main Results:
- Open pleural biopsy demonstrated high diagnostic accuracy (95% sensitivity, 100% specificity).
- Closed blind pleural biopsies had low sensitivity (16%) but high specificity (94%), with 32% inadequacy rate.
- CT-guided biopsies achieved 100% accuracy.
- Larger specimen size (>10 mm) significantly improved diagnostic yield compared to smaller specimens (<10 mm).
Conclusions:
- Open pleural biopsy is the most accurate method for diagnosing all subtypes of malignant pleural mesothelioma.
- Closed blind biopsy accuracy is limited and influenced by specimen size and tumor subtype.
- CT-guidance improves the accuracy of closed pleural biopsies.
