Videothoracoscopy in the Diagnosis and Treatment of Malignant Pleural Mesothelioma with Associated Pleural Effusions

Cantó, A.; Guijarro, Ricardo; Arnau, A.; Galbis, Jose M.; M, Martorell Cebollada; Aguado, R.

doi:10.1055/s-2007-1013677

Cited by 39 publications

(13 citation statements)

References 3 publications

(4 reference statements)

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“…Similar results were reported by many investigators [4,5,12,16]. However, in other studies, the pleural fluid cytology yielded lower results, [8,21].…”

Section: Discussionsupporting

confidence: 89%

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Mohamed

Mobasher

Yousef

et al. 2000

Lung

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Patients with pleural effusions frequently present a diagnostic and therapeutic challenge. The diagnosis is based on the interpretation of the results of thoracentesis or pleural biopsy. When a malignant tumor metastasizes to the pleura, tumor cells can be seeded over the mesothelial surface or in the subserous layer. In the former situation, tumor cells are abundant in pleural fluid, but in the latter, few malignant cells are exfoliated into the pleural cavity, and microscopic deposits may not be visualized at thoracoscopy. Pleural lavage cytologic study at the time of thoracoscopy has not been studied. The purpose of this study was to assess the value of thoracoscopic pleural lavage as an adjuvant in the diagnostic workup of patients with exudative pleural effusions. Fifty patients with exudative pleural effusions were investigated by pleural fluid cytologic findings, Abram's pleural biopsy, thoracoscopy, and pleural lavage cytologic findings. After aspiration of all pleural fluid, 300 mL saline was instilled into the pleural cavity and then recovered for cytologic analysis. The final diagnoses were 32 malignant (64%), 15 tuberculous (30%), and 3 idiopathic (6%) effusions. In the malignant group, thoracoscopic biopsy had the highest yield (94%) followed by lavage cytologic analysis (84%), fluid cytologic analysis (62%), and biopsy with Abram's needle (50%). The sensitivity of combined thoracoscopy and lavage cytologic analysis was 96%. In the patients with tuberculous pleuritis, the yield from the pathologic examination of the biopsy specimen was 93% with thoracoscopy and 60% with the Abrams needle. The diagnostic yield with cytologic analysis on pleural lavage fluid is significantly higher than that on pleural fluid. This is probably because the cells in the lavage fluid are fresher and better preserved than those in the regular pleural fluid, which may have undergone degenerative changes, yielding false-negative results. Pleural lavage cytologic analysis should be performed in patients with suspected malignant pleural effusion who are subjected to diagnostic thoracoscopy, because it may provide additional information to thoracoscopic biopsy.

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“…Similar results were reported by many investigators [4,5,12,16]. However, in other studies, the pleural fluid cytology yielded lower results, [8,21].…”

Section: Discussionsupporting

confidence: 89%

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Mohamed

Mobasher

Yousef

et al. 2000

Lung

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“…On the basis of previous scientific literature 17 and a local audit, 12 we estimated 1-year overall survival to be 37% with talc pleurodesis and 59% with VAT-PP. To show this difference we needed 90 patients per group (5% two-sided significance) to give 80% power.…”

Section: Discussionmentioning

confidence: 97%

Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial

et al. 2014

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SummaryBackground Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma.

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“…12) Needle biopsy was a diagnostic procedure for only 2 patients (5%) and a diagnosis was made by thoracoscopy in 25%; the other patients (70%) required an open pleural biopsy for the tissue diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Malignant Pleural Mesothelioma: Clinicopathologic and Survival Characteristic in a Consecutive Series of 40 Patients

Bagheri

Haghi

Rahim

et al. 2011

ATCS

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Introduction: Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occurs after prolonged exposure to asbestos. Different types of surgical and oncological therapeutic methods have been used resulting in various outcomes. The aim of this study was to evaluate, clinicopathologically, 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis. Methods: In this study, 40 patients with a definitive diagnosis, who had been followed up for at least 3 years were studied according to these: epidemiologic factors, stage and pathological types, treatment method and complications, and by using factors that influence patients survival, we evaluated them statistically. Results: The M/F ratio was l3/1 with an average age of 55 years. Chest pain was the most common symptom. In 55% of patients, the lesions were localized in the left site and most were in Buchart stage I or II. The epithelial form was the most common pathological pattern (62.5%). 47.5% of patients only received radiotherapy and chemotherapy. Of patients who underwent decortication and pleurectomy with adjuvant therapy, extrapleural was performed in 20% of patients, and pneumonectomy, in 17.5%; and 15% refused any type of treatment. One patient died from the surgery. The most common surgical complication was wound infection. The average survival was 10.5 months, and the main factors influencing the survival were physiologic status, pathological form of disease, stage of disease and the pattern of pleural involvement. Conclusion: Because of the low survival after multimodality invasive treatments in mesothelioma, aggressive therapeutic methods were recommended in patients with good physiological status and early clinical stage with a good pathology type.

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Videothoracoscopy in the Diagnosis and Treatment of Malignant Pleural Mesothelioma with Associated Pleural Effusions

Cited by 39 publications

References 3 publications

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Pleural Lavage: A Novel Diagnostic Approach For Diagnosing Exudative Pleural Effusion

Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial

Malignant Pleural Mesothelioma: Clinicopathologic and Survival Characteristic in a Consecutive Series of 40 Patients

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