Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time?

Our plain-English summary of Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time?, by E. Roca, A. Aujayeb, P. Astoul (Current Oncology, 2024).

The study

• Authors: E. Roca, A. Aujayeb, P. Astoul
• Journal: Current Oncology
• Published: 2024;31(9):4968-4983
• Type of article: Review
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Ranked high in worldwide growing health issues, pleural diseases affect approximately one million people globally per year and are often correlated with a poor prognosis. Among these pleural diseases, malignant pleural mesothelioma (PM), a neoplastic disease mainly due to asbestos exposure, still remains a diagnostic challenge. Timely diagnosis is imperative to define the most suitable therapeutic approach for the patient, but the choice of diagnostic modalities depends on operator experience and local facilities while bearing in mind the yield of each diagnostic procedure. Since the analysis of pleural fluid cytology is not sufficient in differentiating historical features in PM, histopathological and morphological features obtained via tissue biopsies are fundamental. The quality of biopsy samples is crucial and often requires highly qualified expertise. Since adequate tissue biopsy is essential, medical or video-assisted thoracoscopy (MT or VATS) is proposed as the most suitable approach, with the former being a physician-led procedure. Indeed, MT is the diagnostic gold standard for malignant pleural pathologies. Moreover, this medical or surgical approach can allow diagnostic and therapeutic procedures: it provides the possibility of video-assisted biopsies, the drainage of high volumes of pleural fluid and the administration of sterile calibrated talcum powder under visual control in order to achieve pleurodesis, placement of indwelling pleural catheters if required and in a near future potential intrapleural therapy. In this context, dedicated diagnostic pathways remain a crucial need, especially to quickly and properly diagnose PM. Lastly, the interdisciplinary approach and multidisciplinary collaboration should always be implemented in order to direct the patient to the best customised diagnostic and therapeutic pathway. At the present time, the diagnosis of PM remains an unsolved problem despite MDT (multidisciplinary team) meetings, mainly because of the lack of standardised diagnostic work-up. This review aims to provide an overview of diagnostic procedures in order to propose a clear strategy.

In plain English

This article was a narrative review, by authors working in Italy, the UK and France, of how pleural mesothelioma is diagnosed. It reported no new patient data. The authors described the disease as a rare, aggressive cancer often linked to past asbestos exposure. They reviewed published evidence on imaging, pleural fluid testing, tissue biopsy, molecular and blood markers, breath tests, artificial intelligence, staging and the 2021 WHO classification. Citing earlier research, they reported that fluid cytology was helpful in less than 6% of cases of pleural mesothelioma. They also reported that a study by Sundaralingam and colleagues found molecular marker analysis succeeded in 95% of local anaesthetic thoracoscopy samples, compared with 86% of CT-guided and 77% of ultrasound-guided biopsies. The authors called local anaesthetic thoracoscopy the preferred diagnostic option. They said blood markers and breath tests needed further validation and that artificial intelligence was not yet applicable in clinical practice. The authors concluded that diagnosis remains an unsolved problem, mainly because there is no standardised diagnostic work-up. They noted that the review effectively reflects the authors' own opinions and practice.

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 (expert review) of published evidence on the diagnosis of pleural mesothelioma; no original data
• Who was studied: No patients were studied; the review covered published literature on diagnostic procedures for pleural mesothelioma
• Exposure: No exposure was studied. As background, the review describes pleural mesothelioma as mainly due to asbestos exposure and divides asbestos into serpentine and amphibole (amosite and crocidolite) fibres
• Main results:
  • Citing previous research, the review stated that pleural fluid cytology is helpful in less than 6% of cases of pleural mesothelioma
  • Citing Sundaralingam et al., the review reported yields for successful molecular marker analysis of 95% for local anaesthetic thoracoscopy (LAT), 86% for CT-guided biopsies and 77% for ultrasound-guided biopsies
  • The authors described LAT as the preferred option for diagnosis, with diagnostic yields often quoted as above 95%
  • Citing earlier work, the review stated that approximately 40% of CT scans can be reported as benign despite an underlying malignant diagnosis
  • Citing the TARGET trial, the review stated that PET-CT is not useful for guiding new pleural biopsies after a previous non-diagnostic biopsy
  • Citing a previous study, the review gave the sensitivity and specificity of serum mesothelin levels as 0.61 and 0.8; it stated that other markers (Fibulin-3, Osteopontin, MPF, Hyaluronic acid) are not recommended for routine use
  • The authors stated that exhaled-breath tests require large-scale validation
  • The authors stated that artificial intelligence is not yet applicable in clinical practice for pleural mesothelioma
• The authors' conclusion: The authors concluded that diagnosis of pleural mesothelioma remains an unsolved problem despite multidisciplinary team meetings, mainly because of the lack of a standardised diagnostic work-up
• Limitations the authors state:
  • The authors stated that the review effectively constitutes an expert review of their own opinions and practice

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Asbestos Exposure, Fluid Cytology, Biopsy, Thoracoscopy, Video-Assisted Thoracoscopic Surgery (VATS), Pleurodesis.

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