Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 1: Diagnosis

Abstract

Background. To compare the diagnostic value of thoracoscopic biopsy, fluid cytology, and Abrams needle biopsy, the authors analyzed prospectively the records of 188 patients with malignant pleural mesothelioma examined between 1973 and 1990. Symptoms were pleural effusion in 173 patients, empyema in 1, spontaneous pneumothorax in 1, and radiologic tumor without effusion in 13. Methods. Thoracoscopy was performed using a rigid thoracoscope under local anesthesia with neuroleptanalgesia. A total of 10–20 biopsies were taken from the parietal, diaphragmatic, and visceral pleura. Each diagnosis was confirmed by the French panel of mesothelioma pathologists. To prevent parietal seeding, radiation therapy at a dose of 21 Gy was administered during a period of 3 days to all points of entry. Results. Tolerance to thoracoscopy was good. The only complications were subcutaneous emphysema (1 patient), local pleural infection (4 patients), hemorrhage of less than 100 ml (3 patients), and temperature of 38–38.5°C (26 patients). In 137 patients, the cavity was free, and complete endoscopic inspection was achieved. In 51 patients, inspection was limited by adhesions that were severed to obtain biopsy. Nonspecific inflammation was observed in 12 patients (6.5%), nodules in 92 (49%), thickening in 21 (11%), and mixed lesions in 63 (33.5%). Diagnosis was achieved by thoracoscopy in 98% of patients, by fluid cytology in 26%, and by needle biopsy in 21%. Conclusion. In most patients, thoracoscopy allows complete visualization of the pleural cavity and provides high‐quality biopsy samples. The diagnostic accuracy of thoracoscopy is similar to open thoracotomy, but the procedure is far less invasive, usually requiring that the patient remain in the hospital only 1 day.

A randomised trial of single-dose radiotherapy to prevent procedure tract metastasis by malignant mesothelioma

“…The French nonrandomised series and subsequent randomised trial used higher energy 12 -15 MeV electrons (Boutin and Rey, 1993;Boutin et al, 1995), while the British study employed 140-or 250-kV photons (Low et al, 1995). These alternative radiations give a higher dose beyond approximately 3 cm depth in tissue.…”

“…These subcutaneous masses are often symptomatic and refractory to radiotherapy (RT) (Davis et al, 1994). Two nonrandomised series and one randomised controlled trial have demonstrated that a prophylactic three-fraction course of RT reduces the procedure tract metastasis rate to 0% (Boutin and Rey, 1993;Boutin et al, 1995;Low et al, 1995). Recent reviews and guidelines recommended prophylactic radiotherapy following thoracic procedures (BTSSCC, 2001;Parker and Neville, 2003).…”

Mesotelioma maligno: descripción clínica y radiológica de 45 casos con y sin exposición a asbestos

“…Diversos autores han reconocido el escaso valor del examen citológico del líquido pleural para establecer el diagnósti-co de MM, 3,18,20,21 pues han calculado una sensibilidad diagnóstica de aproximadamente 26%.…”

“…Este estudio notificó una sensibilidad de 26% para el examen citológico del líquido pleural, y de 21% para la biopsia pleural cerrada, con una sensibilidad acumulativa entre los dos procedimientos tan sólo de 38.7%; asimismo, se atribuyó al material obtenido por toracoscopía una sensibilidad diagnóstica de 80%. 20 Nuestros hallazgos concuerdan con lo notificado en estas series.…”

Diagnóstico e estadiamento do câncer de pulmão

“…rado, a toracoscopia aumenta o rendimento diagnóstico e resultados de até 95% de positividade já foram relatados na literatura (45) . A toracoscopia é uma técnica invasiva, mas com baixos índices de mortalidade (< 0,01%) (46) .…”