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Updated: Jun 28, 2025
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Analysis of invasive diagnostic techniques for pathological confirmation of pleural mesothelioma
H Gómez Herrero1, B Álvarez Galván1
1Servicio de Radiología, Hospital Universitario de Navarra, Pamplona, Spain.
Background And Objectives:
Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography.
Materials And Methods:
Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis.
Results:
Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%.
Conclusions:
In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.
Insights
Image-guided pleural biopsy offers the highest diagnostic yield for mesothelioma, a cancer linked to asbestos exposure. This method should be the initial invasive diagnostic test for suspected mesothelioma cases.
Area of Science:
- Oncology
- Pulmonology
- Diagnostic Imaging
Background:
- Mesothelioma, a rare cancer with poor prognosis, is linked to asbestos exposure and peaks in Europe around 2020.
- Diagnosis is challenging, requiring imaging and invasive pleural techniques for pathological confirmation.
- Varied diagnostic yields of invasive techniques are documented in medical literature.
Approach:
- Retrospective review of 26 pleural mesothelioma cases diagnosed between 2019-2021.
- Analysis included demographic data, asbestos exposure history, radiological findings, and invasive diagnostic procedures.
- Comparison of diagnostic yields for cytology, non-image-guided biopsy, image-guided biopsy, and surgical biopsy.
Key Points:
- Median patient age was 74 years, with 22 men and 4 women; 9 patients reported asbestos exposure.
- Moderate-to-severe pleural effusion was the most common radiological finding (23/26 cases).
- Diagnostic sensitivities: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%.
Conclusions:
- Image-guided pleural biopsy demonstrated the highest diagnostic yield (93%) in this cohort.
- This technique should be considered the primary invasive diagnostic procedure for mesothelioma.
- Findings align with literature suggesting advanced imaging guidance improves diagnostic accuracy for pleural malignancies.
