Achieving Molecular Profiling in Pleural Biopsies: A Multicenter, Retrospective Cohort Study

Area of Science:

• Oncology
• Pulmonology
• Pathology

Background:

• Malignant pleural effusions require accurate molecular profiling for targeted therapy selection.
• Previous studies highlight pleural biopsy's diagnostic sensitivity over pleural fluid analysis.
• The adequacy of different pleural biopsy techniques for molecular marker analysis remains understudied.

Purpose of the Study:

• To evaluate the adequacy of various pleural biopsy techniques in obtaining molecular diagnostic information for malignant pleural effusions.
• To identify factors influencing the success of molecular profiling from pleural biopsies.

Main Methods:

• Analysis of anonymized data from 183 patients with confirmed malignant pleural effusions across three countries.
• Comparison of molecular marker analysis success rates across local anesthetic thoracoscopy (LAT), CT-guided, and ultrasound-guided pleural biopsy techniques.
• Statistical analysis to determine associations between biopsy technique, sample size, and successful molecular profiling.

Main Results:

• Local anesthetic thoracoscopy (LAT) demonstrated the highest success rate (95%) for molecular marker analysis, followed by CT-guided (86%) and ultrasound-guided (77%) biopsies.
• Both biopsy technique and sample size were independently associated with successful molecular marker analysis.
• LAT significantly increased the odds of a successful molecular diagnosis (OR 30.16).

Conclusions:

• Local anesthetic thoracoscopy (LAT) is the optimal diagnostic tool for achieving molecular profiling in malignant pleural effusions.
• Image-guided biopsy techniques are less effective for obtaining actionable molecular histology.
• These findings support an evidence-based approach to diagnostic investigation for guiding targeted therapies.