Thoracoscopy in pleural malignant mesothelioma diagnosis

Our plain-English summary of Thoracoscopy in pleural malignant mesothelioma diagnosis, by G.F. Tassi, G.P. Marchetti, F. Fattibene, et al (Diagnostic and Therapeutic Endoscopy, 1997).

The study

• Authors: G.F. Tassi, G.P. Marchetti, F. Fattibene, P.L. Chiodera
• Journal: Diagnostic and Therapeutic Endoscopy
• Published: 1997;3(3):147-51
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

On the basis of our personal experience in 70 cases (66 pleural effusions) observed during the period January 1984- January 1996 we are here illustrating and discussing the diagnostic role of thoracoscopy in malignant pleural mesothelioma.A histological diagnosis was achieved in 94.2% of cases. The endoscopic appearance was clearly neoplastic (masses, nodules) in 53 patients (75.7%) and simply inflammatory in 17 pachypleuritis in 13 (18.6%) and of diffuse hyperemia in 3 (5.7%). In all cases fluid cytology (diagnostic yield: 18.5%) and needle biopsy (diagnostic yield 17.1%) were performed.The extension of pleural involvement (endoscopic staging according to Boutin) was also determined. In 16 patients (22.8%) a parietal and diaphragmatic involvement (stage Ia) was found. In 40 patients (57.2%) an associated visceral invasion (stage Ib). In 14 cases (20%) a diffuse parietal, visceral and mediastinal extension (stage II). The exam has always been well tolerated with few immediate complications: subcutaneous emphysema (4 cases) and some negligeable parietal bleeding (2 cases).

In plain English

This report described the authors' experience using thoracoscopy, a camera examination of the chest cavity, to diagnose malignant pleural mesothelioma in 70 patients seen from January 1984 to January 1996 at the Spedali Civili in Brescia and then the Ospedale di Valle Camonica, Italy. Occupational asbestos exposure was definitely positive by history in 17 (24.2%). Biopsies taken during thoracoscopy gave the diagnosis in 66 of 70 (94.2%). Fluid cytology did so in 13 of 70 (18.5%) and needle biopsy in 12 of 70 (17.1%). Clearly cancerous-looking lesions were seen in 75.7% of patients. Plaques resembling asbestos-related plaques were seen in 13 (18.6%). Lung biopsies in 3 patients showed pulmonary asbestosis. There were no major complications immediately after the procedure. Minor ones were subcutaneous emphysema in 4 patients and minor bleeding in 2. Cancer grew into the chest scar in 3 patients, all among the first 31, who had no local radiotherapy. The authors concluded that thoracoscopy has a fundamental role in diagnosing and treating mesothelioma. They noted that too few patients received early-stage treatment to draw conclusions about it.

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 series: a report of the authors' own experience with diagnostic thoracoscopy
• Who was studied: 70 patients with pleural malignant mesothelioma diagnosed at thoracoscopy at two Italian hospitals: the Pneumology Division of the Spedali Civili in Brescia (1984-1986), then the Pneumology Division of the Ospedale di Valle Camonica (1987-1996). There were 49 men and 21 women, with an average age of 61 years (range 41 to 84). 66 had pleural effusion. They came from a total of 470 diagnostic thoracoscopies for pleural disease of unknown cause.
• Exposure: Occupational asbestos exposure, based on patient history, was definitely positive in 17 patients (24.2%) and negative or unclear in the other 53. No fiber types were named.
• Main results:
  • Thoracoscopic biopsy gave a diagnosis of pleural malignant mesothelioma in 66 of 70 patients (94.2%).
  • In the same patients, pleural needle biopsy was diagnostic in 12 of 70 (17.1%) and fluid cytology in 13 of 70 (18.5%).
  • Clearly neoplastic lesions (vegetations, nodules, multiple lesions) were seen in 75.7% of patients. About one quarter showed only inflammation or pachypleuritis (pleural thickening).
  • Fibrohyaline plaques with the characteristics of asbestotic plaques were seen in 13 of the 70 patients (18.6%).
  • In all 3 patients who had a lung tissue biopsy with coagulating forceps, the diagnosis was pulmonary asbestosis.
  • Histological type was epithelial in 55 patients (78.6%), sarcomatous in 5 (7.1%), mixed cell in 7 (10%) and other in 3 (4.3%).
  • Staging found disease limited to the parietal and diaphragmatic pleura (stage Ia) in 16 patients, visceral invasion (stage Ib) in 40 (57.2%), and invasion of all pleural surfaces (stage II) in 14 (20%).
  • Talc poudrage was done in 29 patients. It gave permanent pleurodesis with no recurrence of effusion in 24 (83%).
  • There were no major complications immediately after the procedure. Minor complications were subcutaneous emphysema in 4 patients (5.7%) and minor parietal bleeding in 2 (2.8%).
  • As a later complication, tumor invaded the thoracic scar in 3 patients (4.3%). All 3 were among the first 31 patients, who had not received local radiotherapy. It did not occur in the 39 who received radiotherapy.
• The authors' conclusion: The authors concluded that the role of thoracoscopy in mesothelioma is fundamental for both diagnosis and treatment, and that it should be used systematically in all suspicious cases.
• Limitations the authors state:
  • Too few early-stage patients were treated (3 by pleurectomy, 6 with intracavitary drugs) to draw conclusions about that treatment.
  • Thoracoscopy does not reach 100% sensitivity. False negatives are usually due to adhesions that prevent complete exploration of the pleural cavity.

Topics

Medical terms in this study, explained in our Lexicon: Thoracoscopy, Mesothelioma, Pleural Effusion, Pleural Mesothelioma, Fluid Cytology, Needle Biopsy, Staging, Stage IA.

Related studies

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• Thoracoscopy in the early diagnosis of malignant pleural effusions — C. Boutin, P. Cargnino, et al. (1980)
• Thoracoscopy: a useful tool in the diagnosis of thoracic disease — J.I. Miller, C.R. Hatcher (1978)
• Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis — Y. Wei, K. Shen, et al. (2020)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
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