image du produit
Radiologic Clinics of North America

S'abonner

PERCUTANEOUS NEEDLE BIOPSY OF THE PLEURA - 06/09/11

Doi : 10.1016/S0033-8389(05)70164-0 
Nicholas J. Screaton, BM BChir, MRCP, FRCR *, Christopher D.R. Flower, MB BChir, FRCP(C), FRCR *

Résumé

Pleural disease of inflammatory, infectious, or malignant origin frequently results in pleural thickening often accompanied by pleural fluid. The most frequent clinical manifestation is chest pain, which usually is intermittent and pleuritic in inflammatory or infective disease, and constant when there is malignant involvement. Dyspnea may be related to underlying lung disease, lung restriction caused by pleural encasement, or an associated pleural effusion.

The chest radiograph is the usual first-line investigation when pleural disease is suspected. The typical changes are pleural thickening, which may be localized or diffuse, or a pleural effusion. Cross-sectional imaging techniques, particularly ultrasound (US) and CT, may be used to detect both effusions31 and thickened pleura, and to characterize further the nature of the changes.3, 12, 21, 41, 51 Cytologic analysis of pleural fluid is a sensitive but nonspecific technique in detecting malignant disease; therefore pleural biopsy often is required to establish a diagnosis. When pleural histology is analyzed in combination with cytology from thoracentesis, the diagnostic yield is significantly increased and allows a precise diagnosis to be made in the majority of patients.14, 19, 40, 43, 49 With histologic samples it is not only possible to differentiate accurately between benign inflammatory disease and malignancy but it is also possible to subclassify malignant cell types. This is important in the management of chemosensitive malignancies, including lymphoma, metastatic ovarian, and small cell lung carcinoma. The importance of an accurate diagnosis in mesothelioma relates to claims for compensation.

Cope10 and Abrams1 pleural biopsy needles were developed in the 1950s as a means of obtaining untargeted or closed biopsies from the surface of the parietal pleura. The diagnostic yield of such unguided pleural biopsy has remained low,48 however, and the procedure is restricted to patients with pleural effusions. Image guidance using US,8, 35, 37 CT,16, 17, 35, 46 or fluoroscopy4 enables targeted biopsy of abnormal pleura even when it is focal or otherwise relatively inaccessible or when pleural fluid is minimal or absent.46 This has led to a substantial increase in the yield of pleural biopsy. The introduction of automated biopsy needles, which produce excellent cores with minimal crush artifact, and the use of immunohistochemical techniques15, 26, 38 have further increased the accuracy of pleural biopsy.

Le texte complet de cet article est disponible en PDF.

Plan


 Address reprint requests to N. J. Screaton, BM BChir, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, United Kingdom


© 2000  W. B. Saunders Company. Publié par Elsevier Masson SAS. Tous droits réservés.
Imprimer
Export

    Export citations

  • Fichier

    •

  • Contenu

    •

Vol 38 - N° 2

P. 293-301 - mars 2000 Retour au numéro
Article précédent Article précédent
  • TRANSTHORACIC HILAR AND MEDIASTINAL BIOPSY
  • Zenon Protopapas, Jack L. Westcott
| Article suivant Article suivant
  • CT FLUOROSCOPY FOR THORACIC INTERVENTIONAL PROCEDURES
  • Charles S. White, Cristopher A. Meyer, Philip A. Templeton

Déjà abonné à cette revue ?