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Clinical feature of diagnostic challenging cases for pleural biopsy in patient with malignant pleural mesothelioma. Gen Thorac Cardiovasc Surg 2020; 68:820-827. [PMID: 31981139 DOI: 10.1007/s11748-020-01295-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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.
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Hasegawa S, Kondo N, Matsumoto S, Takuwa T, Hashimoto M, Kuroda A, Nakamichi T, Kamikonya N, Tsujimura T, Nakano T. Surgical Risk and Survival Associated With Less Invasive Surgery for Malignant Pleural Mesothelioma. Semin Thorac Cardiovasc Surg 2019; 31:301-309. [DOI: 10.1053/j.semtcvs.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/11/2022]
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Gopar-Nieto R, Aguilar-Madrid G, Sotelo-Martínez L, Juárez-Pérez CA, Kelly-García J, Argote-Greene L, Ochoa-Vázquez MD, García-Bazán EM, Ramírez-Pérez J, Haro-García L, Jiménez-Ramírez C, Cabello-López A. Malignant Pleural Mesothelioma: Accuracy of CT Against Immunohistochemical Test Among the Mexican Population. Arch Med Res 2015; 46:107-11. [PMID: 25707292 DOI: 10.1016/j.arcmed.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Malignant pleural mesothelioma (MPM) is associated with occupational and environmental exposure to asbestos. The incidence is expected to increase as the use of asbestos is not prohibited in many countries, such as in Mexico. We undertook this study to determine sensitivity, specificity, predictive values and likelihood ratios of computed tomography (CT) in a sample from Mexican population with suspected MPM and other pleuropulmonary diseases. METHODS CT films of 38 patients suspected of having MPM were analyzed. A single observer was blinded to MPM diagnoses. The frequencies of ten CT findings were identified. A cut-off point of ≥5 CT findings was established to determine high MPM probability. Sensitivity, specificity, predictive values and likelihood ratio of the CT against biopsy using immunohistochemical testing (IHC) for MPM were calculated. RESULTS Of the 38 patients, 31 had MPM and seven had lung adenocarcinoma. The five key findings were mediastinal pleural thickening 96.7% (n = 30), nodular pleural thickening 93.3% (n = 29), pleural mass 83.9% (n = 26), diminished lung 70.9% (n = 22) and contracted hemithorax 70.9% (n = 22). Sensitivity 96.8% (83.2-99.4), specificity 85.7% (42.2-97.6), positive likelihood ratio 6.7 (1.1-41.6), and negative likelihood ratio of 0.04 (0.01-0.2) were reported. CONCLUSIONS Sensitivity and specificity in this study was greater than previously reported, 96.8% and 85.7 vs. 93.2 and 65.6%, respectively. CT is an easily accessible and useful tool that should be incorporated into the medical education of general physicians to improve MPM diagnosis of suspected cases.
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Affiliation(s)
- Rodrigo Gopar-Nieto
- Occupational Health Research Unit, Health Research Coordination, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Guadalupe Aguilar-Madrid
- Occupational Health Research Unit, Health Research Coordination, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México.
| | | | - Cuauhtémoc Arturo Juárez-Pérez
- Occupational Health Research Unit, Health Research Coordination, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Javier Kelly-García
- Department of Thoracic Surgery, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Luis Argote-Greene
- Department of Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Secretaría de Salud, México, D.F., México
| | - María Dolores Ochoa-Vázquez
- Department of Neumology, Hospital General, CMN La Raza, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Eric Marco García-Bazán
- Department of Thoracic Surgery, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Jorge Ramírez-Pérez
- Department of Radiology, Hospital General, CMN La Raza, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Luis Haro-García
- Occupational Health Research Unit, Health Research Coordination, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Carmina Jiménez-Ramírez
- Clinical Analysis Laboratory, Unidad Médica de Alta Especialidad, Hospital de Traumatología "Dr. Victorio de la Fuente Narvaez", Instituto Mexicano del Seguro Social, México, D.F., México
| | - Alejandro Cabello-López
- Occupational Health Research Unit, Health Research Coordination, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
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