G Clinical feature of diagnostic challenging cases for pleural biopsy in patient with malignant pleural mesothelioma
- 1 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in General Thoracic and Cardiovascular Surgery
- Vol. 68 (8), 820-827
- https://doi.org/10.1007/s11748-020-01295-5
Abstract
Objective Pleural biopsy through video-assisted thoracic surgery (VATS pleural biopsy) is the most reliable diagnostic procedure for malignant pleural mesothelioma (MPM). However, definitive diagnosis of MPM is occasionally difficult to establish. This study aims to investigate clinicopathological features of MPM patients who failed diagnosis by the first VATS pleural biopsy. Methods Four hundred consecutive patients with suspected MPM who received VATS pleural biopsy between March 2004 and July 2017 were enrolled in this retrospective study. Patients, whose histological diagnoses were not definitive in the first VATS pleural biopsy, were followed up as atypical mesothelial proliferation (AMP) or non-specific pleuritis (NSP). Re-examination was performed in cases strongly suspected of having MPM. Results Of the 400 patients, 267 (66.8%) were pathologically diagnosed with MPM, 25 with metastatic carcinoma and 6 with benign pleural disease by the first VATS pleural biopsy. Of the remaining 102 patients diagnosed with AMP or NSP, 10 patients (9.8%) were subsequently diagnosed with MPM. Analysis of the clinical course revealed that only insufficient tissue for diagnosis was obtained via VATS pleural biopsy in all cases and that it was caused by very early stage without visible tumour in 4 patients, intrathoracic inflammation in 4 and desmoplastic MPM in 2. Conclusions In our review, 9.8% of patients diagnosed with AMP or NSP in first VATS pleural biopsy were subsequently diagnosed with MPM due to insufficient tissue for diagnosis. Definitive diagnosis via VATS pleural biopsy is sometimes challenging in following situation; very early stage, intrathoracic inflammation and desmoplastic MPM.This publication has 29 references indexed in Scilit:
- Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest GroupArchives Of Pathology & Laboratory Medicine, 2018
- Current surgical strategies for malignant pleural mesotheliomaSurgery Today, 2015
- Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant MesotheliomaActa Cytologica, 2015
- Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2012 Update of the Consensus Statement from the International Mesothelioma Interest GroupArchives of Pathology & Laboratory Medicine, 2013
- Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma DatabaseJournal of Thoracic Oncology, 2012
- Practical approaches to diagnose and treat for T0 malignant pleural mesothelioma: a proposal for diagnostic total parietal pleurectomyInternational Journal of Clinical Oncology, 2012
- Early mesothelioma revisitedInternational Journal of Clinical Oncology, 2012
- Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesotheliomaEuropean Respiratory Journal, 2009
- Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: A Consensus Statement from the International Mesothelioma Interest GroupArchives of Pathology & Laboratory Medicine, 2009
- Cytological diagnosis of malignant mesothelioma—improvement by additional analysis of hyaluronic acid in pleural effusionsVirchows Archiv, 2007