Malignant pleural mesothelioma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Our plain-English summary of Malignant pleural mesothelioma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration, by B. Kang, M.A. Kim, B.Y. Lee, et al (Tuberculosis and Respiratory Diseases, 2013).

The study

• Authors: B. Kang, M.A. Kim, B.Y. Lee, H. Yoon, D.K. Oh, H.S. Hwang, C. Choi
• Journal: Tuberculosis and Respiratory Diseases
• Published: 2013;74(2):74-8
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 61-year-old woman came to the hospital with dyspnea and pleural effusion on chest radiography. She underwent repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis, but diagnosis of her was uncertain. Positron emission tomography showed multiple lymphadenopathies, so she underwent endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. Here, we report a case of malignant pleural mesothelioma that was eventually diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. This is an unusual and first case in Korea.

In plain English

This article was a case report about one patient, a 61-year-old woman treated at Asan Medical Center in Seoul, Korea. She had fluid around the lung (pleural effusion) and a lung that had collapsed more than once (recurrent pneumothorax). Several earlier tests failed to give a diagnosis: repeated drawing of fluid from the chest, a lung biopsy and lung washing done through a bronchoscope, and a pleural biopsy done through a thoracoscope with talc treatment. A surgical biopsy by video-assisted thoracoscopic surgery was considered but not done because of pleural adhesion. A PET scan showed active lymph nodes in the chest, so doctors took needle samples from three of them using an ultrasound-guided bronchoscope (EBUS-TBNA). Staining of the tumor cells pointed to malignant mesothelioma rather than lung adenocarcinoma. She was diagnosed with malignant pleural mesothelioma at stage IV and began chemotherapy two weeks later. The authors described this as the first case diagnosed by this method after surgical biopsy proved impossible, and as the first such case in Korea. The article did not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 61-year-old woman with pleural effusion and recurrent pneumothorax, admitted to Asan Medical Center, Seoul, Korea (dates of care not given)
• Main results:
  • Repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis were all non-diagnostic in this patient.
  • A biopsy by video-assisted thoracoscopic surgery (VATS) was considered but not performed because of pleural adhesion.
  • PET showed hyper-metabolic lesions in right upper paratracheal, right lower paratracheal, subcarinal, and right interlobar lymph nodes.
  • EBUS-TBNA obtained adequate tissue from 3 aspirations of the right upper paratracheal node (#2R), 2 of the subcarinal node (#7), and 3 of the right interlobar node (#11R).
  • Tumor cells showed papillary architecture. They stained positive for calretinin, cytokeratin 5/6 and Wilms tumor 1, and negative for thyroid transcription factor-1. The authors judged this pattern consistent with malignant mesothelioma rather than pulmonary adenocarcinoma.
  • PET showed lymph node enlargement in both supraclavicular areas (N3). The patient's clinical stage was IV, and she received chemotherapy (printed as premetrexed/cisplatin) two weeks after diagnosis.
• The authors' conclusion: The authors stated that this was the first case diagnosed as malignant pleural mesothelioma by EBUS-TBNA when VATS was impossible, after thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage and thoracoscopic pleural biopsy had failed. They also stated it was the first case diagnosed this way in Korea, and called it an unusual case.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Ultrasound, Dyspnea, Pleural Effusion, Thoracentesis, Biopsy, Bronchoalveolar Lavage (BAL), Pleural Biopsy.

Related studies

• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)

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