Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine (EFSUMB) Guidelines: Rare Malignant Pulmonal and Pleural Tumors: Primary Pulmonary Sarcoma and Mesothelioma, Imaging Features on Transthoracic Ultrasound

Our plain-English summary of Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine (EFSUMB) Guidelines: Rare Malignant Pulmonal and Pleural Tumors: Primary Pulmonary Sarcoma and Mesothelioma, Imaging Features on Transthoracic Ultrasound, by K. Möller, F. Dietz, M. Ludwig, et al (Diagnostics, 2024).

The study

• Authors: K. Möller, F. Dietz, M. Ludwig, S. Eisenmann, C. Görg, E. Safai Zadeh, W. Blank, C. Jenssen, V. Vetchy, B. Möller, C.F. Dietrich
• Journal: Diagnostics
• Published: 2024;14(20)
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pulmonary sarcoma and mesothelioma are rare malignancies. The review article discusses the appearance of these tumors in B-mode ultrasound (US), color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). In particular, the article is intended to inspire the examination of thoracic wall tumors and pleural masses with the possibilities of ultrasonography and to obtain histologically evaluable material using US or CEUS-guided sampling.

In plain English

This article was a review with illustrative patient cases. It looked at how two rare cancers, primary pulmonary sarcoma and mesothelioma, appear on ultrasound of the chest, including contrast-enhanced ultrasound (CEUS). The authors reported that they found no human case reports of CEUS in primary pulmonary sarcoma, only reports from veterinary medicine. In one sarcoma case of their own, CEUS separated collapsed lung, which enhanced early, from the sarcoma, which enhanced later. They wrote that no specific CEUS enhancement pattern of pleural mesothelioma had been described. In their own two mesothelioma cases, CEUS showed arterial enhancement and washout. Two illustrated mesothelioma patients had a reported history of asbestos exposure, two had no reported history of exposure, and one case description gave no exposure history. Citing a study by Iadevaia et al., they reported that ultrasound-guided biopsy diagnosed mesothelioma in 83% of patients. The authors concluded that extensive pleural thickening, which can surround the entire lung, suggests mesothelioma, especially with a history of asbestos contact. They added that the diagnosis has to be confirmed by examining tissue under the microscope.

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: Narrative review of published literature, with illustrative cases from the authors' own practice
• Who was studied: Published literature on primary pulmonary sarcoma and mesothelioma, plus individual illustrative patient cases shown in figures (no defined study group)
• Exposure: Not an exposure study. The subject was imaging: B-mode ultrasound, color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). Asbestos exposure appeared only in the background and in some case descriptions.
• Main results:
  • The authors found no case reports of CEUS in human primary pulmonary sarcoma. Only veterinary case series (dogs and cats) were found.
  • In the authors' illustrated case of primary lung sarcoma, collapsed (atelectatic) lung enhanced early through the pulmonary artery circulation. The sarcoma showed later centripetal enhancement and areas that did not enhance (necrotic).
  • The authors reported that a specific contrast-enhancement pattern of pleural mesothelioma on CEUS had not been described.
  • In the authors' own experience with CEUS in two mesothelioma cases, both showed arterial enhancement and parenchymal washout.
  • Among the illustrated mesothelioma cases, an 80-year-old patient with epithelioid mesothelioma had a history of asbestos exposure.
  • A male patient with epithelioid mesothelioma of the mediastinal pleura reported asbestos exposure about 45 years earlier.
  • An 81-year-old woman with epithelioid mesothelioma had no history of known exposure to asbestos.
  • A male patient with mesothelioma had no reported history of asbestos exposure.
  • For another illustrated 80-year-old patient with epithelioid mesothelioma, the case description gave no exposure history.
  • In a study the review cites (Iadevaia et al.), ultrasound-guided percutaneous needle biopsy diagnosed mesothelioma in 83% of patients.
  • The article states that histological examination of material from the pleural masses is the gold standard for confirming the diagnosis.
• The authors' conclusion: The authors concluded that extensive findings of pleural thickening, which can surround the entire lung and extend into the interlobular space, suggest mesothelioma, especially with a history of asbestos contact. They added that the diagnosis has to be confirmed histologically, and that CEUS can help delineate the tumor and target biopsies.
• Limitations the authors state:
  • Transthoracic ultrasound can only assess lesions that are not covered by normal lung tissue or lung artifacts.
  • Even under optimal conditions, ultrasound can depict only about two-thirds of the pleural surface because of the bony chest wall.
  • There is little published literature on ultrasound findings specific to mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Sarcoma, Mesothelioma, Doppler Ultrasound.

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