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 effusions<sup>31 Lomas D.J., Padley S.G., Flower C.D.R. The sonographic appearance of pleural fluid Br J Radiol 1993 ;  66 : 619  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and thickened pleura, and to characterize further the nature of the changes.<sup>3 Aquino S.L., Webb W.R., Gushiken B.J. Pleural exudates and transudates: Diagnosis with contrast-enhanced CT Radiology 1994 ;  192 : 803

Cliccare qui per andare alla sezione Riferimenti, 12 Dorne H.L. Differentiation of pulmonary parenchymal consolidation from pleural disease using the sonographic fluid bronchogram Radiology 1986 ;  158 : 41

Cliccare qui per andare alla sezione Riferimenti, 21 Hirsch J.H., Rogers J.V., Mack L.A. Real-time sonography of pleural opacities AJR Am J Roentgenol 1981 ;  136 : 297

Cliccare qui per andare alla sezione Riferimenti, 41 Rosenberg E.R. Ultrasound in the assessment of pleural densities Chest 1983 ;  84 : 283  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 51 Yang P.C., Luh K.T., Chang D.B. , e al. Value of sonography in determining the nature of pleural effusion: Analysis of 320 cases AJR Am J Roentgenol 1992 ;  159 : 29

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>14 Frist B., Kaham A.V., Koss L.G. Comparison of the diagnostic values of biopsies of the pleura and cytological evaluation of pleural fluids Am J Clin Pathol 1979 ;  72 : 48

Cliccare qui per andare alla sezione Riferimenti, 19 Hall W.J., Mayeski R. Diagnostic thoracocentesis and pleural biopsy in pleural effusion. Position paper Ann Intern Med 1985 ;  103 : 799

Cliccare qui per andare alla sezione Riferimenti, 40 Prakash U.B., Reiman H.M. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: Analysis of 414 cases Mayo Clin Proc 1985 ;  60 : 158

Cliccare qui per andare alla sezione Riferimenti, 43 Salyer W.R., Eggleston J.C., Erozan Y.S. Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura Chest 1975 ;  67 : 536  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 49 Waite R.J., Carbonneau R.J., Balikian J.P. , e al. Parietal pleural changes in empyema: Appearances at CT Radiology 1990 ;  175 : 145

Cliccare qui per andare alla sezione Riferimenti</sup> 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.

Cope<sup>10 Cope C. New pleural biopsy needle JAMA 1958 ;  167 : 1107

Cliccare qui per andare alla sezione Riferimenti</sup> and Abrams<sup>1 Abrams L.D. New inventions: Pleural-biopsy punch Lancet 1958 ;  1 : 30  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> 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,<sup>48 Tomlinson J.R., Sahn S.A. Invasive procedures in the diagnosis of pleural disease Semin Respir Dis 1987 ;  9 : 30

Cliccare qui per andare alla sezione Riferimenti</sup> however, and the procedure is restricted to patients with pleural effusions. Image guidance using US,<sup>8 Chang D.B., Yang P.C., Luh K.T. , e al. Ultrasound-guided pleural biopsy with Tru-Cut needle Chest 1991 ;  100 : 1328  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 35 Mueller P.R., Saini S., Simeone J.F. , e al. Image-guided pleural biopsies: Indications, technique and results in 23 patients Radiology 1988 ;  169 : 1

Cliccare qui per andare alla sezione Riferimenti, 37 O'Moore P.V., Mueller P.R., Simeone J.F. , e al. Sonographic guidance in diagnostic and therapeutic interventions in the pleural space AJR Am J Roentgenol 1987 ;  149 : 1

Cliccare qui per andare alla sezione Riferimenti</sup> CT,<sup>16 Gleeson F., Lomas D.J., Flower C.D.R. , e al. Powered cutting needle biopsy of the pleura and chest wall Clin Radiol 1990 ;  41 : 199  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 17 Goralnik C.H., O'Connell D.M., El Yousef S.J. , e al. CT-guided cutting-needle biopsies in selected chest lesions AJR Am J Roentgenol 1988 ;  151 : 903

Cliccare qui per andare alla sezione Riferimenti, 35 Mueller P.R., Saini S., Simeone J.F. , e al. Image-guided pleural biopsies: Indications, technique and results in 23 patients Radiology 1988 ;  169 : 1

Cliccare qui per andare alla sezione Riferimenti, 46 Scott E.M., Marshall T.J., Flower C.D.R. Diffuse pleural thickening: Percutaneous CT-guided cutting needle biopsy Radiology 1995 ;  194 : 867

Cliccare qui per andare alla sezione Riferimenti</sup> or fluoroscopy<sup>4 Berquist T.H., Bailey P.B., Cortese D.A. , e al. Transthoracic needle biopsy: Accuracy and complications in relation to location and type of lesion Mayo Clin Proc 1980 ;  55 : 475

Cliccare qui per andare alla sezione Riferimenti</sup> enables targeted biopsy of abnormal pleura even when it is focal or otherwise relatively inaccessible or when pleural fluid is minimal or absent.<sup>46 Scott E.M., Marshall T.J., Flower C.D.R. Diffuse pleural thickening: Percutaneous CT-guided cutting needle biopsy Radiology 1995 ;  194 : 867

Cliccare qui per andare alla sezione Riferimenti</sup> 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 techniques<sup>15 Garcia-Prats M.D., Ballestin C., Sotelo T. , e al. A comparative evaluation of immunohistochemical markers for the differential diagnosis of malignant pleural tumours Histopathology 1998 ;  32 : 462  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 26 Koss M.N., Fleming M., Przygodzki R.M. , e al. Adenocarcinoma simmulating mesothelioma: A clinicopathologic and immunohistochemical study of 29 cases Ann Diagn Pathol 1998 ;  2 : 93

Cliccare qui per andare alla sezione Riferimenti, 38 Ordonez N.G. The immunohistochemical diagnosis of mesothelioma: Differentiation of mesothelioma and lung adenocarcinoma Am J Surg Pathol 1989 ;  13 : 276

Cliccare qui per andare alla sezione Riferimenti</sup> have further increased the accuracy of pleural biopsy.