Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis

Abstract

BackgroundMalignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients.MethodsFrom July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors.ResultsEventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6–20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM.ConclusionsMT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.

Diagnostic value of biopsy sampling in predicting histology in patients with diffuse malignant pleural mesothelioma

“…In the 613 mesotheliomas with concordant histologies between the initial biopsies and surgical resections, the mean number of tissue blocks in the initial biopsies was 3.4 (median, 3; range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], whereas in the 138 mesotheliomas with discordant histologies, the mean number of tissue blocks in the initial biopsies was 2.7 (median, 2; range, 1-9; n = 751; P < .002; Table 4). Similarly, the number of tissue blocks examined was higher in concordant histologies than discordant histologies for thoracoscopic biopsies (n = 720; P < .005) but not for core-needle biopsies (n = 31; P = .56).…”

“…In initial biopsies, a definitive diagnosis can be rendered only if sufficient tissue is present for histologic and immunohistochemical evaluation . Thoracoscopy is the preferred sampling method for the diagnosis of diffuse malignant mesothelioma when it is suspected on the basis of clinical and radiologic information and has reported high accuracy rates of more than 90% . Because of the considerable histologic heterogeneity of diffuse malignant mesothelioma, the final classification of the tumor would require thorough sampling and evaluation in surgical resections and may be expected to differ from the classification derived from initial biopsies .…”

“…15 Thoracoscopy is the preferred sampling method for the diagnosis of diffuse malignant mesothelioma when it is suspected on the basis of clinical and radiologic information and has reported high accuracy rates of more than 90%. [16][17][18][19] Because of the considerable histologic heterogeneity of diffuse malignant mesothelioma, the final classification of the tumor would require thorough sampling and evaluation in surgical resections 15,20,21 and may be expected to differ from the classification derived from initial biopsies. 22 However, correlations between the diagnostic accuracy of the initial biopsies for classifying the types of diffuse malignant mesothelioma and the extent of the biopsy sampling remain unclear.…”

Overexpression of fibulin-3 in tumor tissue predicts poor survival of malignant mesothelioma patients from hand-spinning asbestos exposed area in eastern China

“…Among all the mesothelioma patients, the median expression of fibulin-3 and HMGB1 was 4 (3-4) and 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12), separately (Fig. 2).…”

“…Chemotherapy, radiotherapy and surgery are the main methods for the treatment of mesothelioma, which can provide better survival in a part of mesothelioma patients 8 . However, as mesothelioma was always difficult to be diagnosed at early stage, approximately 50% of the mesothelioma patients died 4-16 months after diagnosis 9 . Thus, it is an urgent need to find more prognostic biomarkers for guiding treatment and prolonging survival time of mesothelioma patients.…”