"Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA)

Our plain-English summary of "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), by F. Lococo, G. Rossi, L. Agostini, et al (Internal Medicine, 2014).

The study

• Authors: F. Lococo, G. Rossi, L. Agostini, A. Filice, M. Paci, C. Rapicetta, T. Ricchetti, S. Tenconi, R. Piro, G. Sgarbi
• Journal: Internal Medicine
• Published: 2014;53(5):467-9
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The acquisition of histologic material is obligatory in order to establish the diagnosis of malignant pleural mesothelioma (MPM). In particular, tissue acquisition in cases of "dry" MPM (focal pleural thickening without pleural effusion or mediastinal lymph node involvement) is usually performed via a thoracoscopic pleural biopsy. In contrast, the techniques for performing echoendoscopic (transbronchial or transesophageal) needle aspiration of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report the first case of "dry" MPM successfully diagnosed via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a 73-year-old man presenting with a pleural mass in the right costovertebral recess, adjacent to the carina. The patient underwent radical resection, and a definitive pathological examination confirmed the diagnosis of epithelioid MPM.

In plain English

This article was a case report from a hospital in Italy. It described a 73-year-old man with no reported tobacco or asbestos exposure who had increasing, long-lasting chest pain. Scans showed a right pleural mass, measured in the text at 43 by 28 mm, next to the carina, where the windpipe divides. The authors called the case "dry" mesothelioma, meaning pleural thickening without fluid around the lung or spread to mediastinal lymph nodes. Doctors took tissue with a thin 22-gauge needle passed through the airway under ultrasound guidance (EBUS-TBNA). They made three passes, and no complications were seen. The tumor cells stained for mesothelial markers (calretinin, CK5/6 and WT-1) but not TTF-1, BerEP4 or CEA, supporting epithelioid malignant mesothelioma. After surgery, the removed tissue confirmed epithelioid malignant pleural mesothelioma. The authors described this as, to their knowledge, the first such case. They concluded EBUS-TBNA is a valid diagnostic procedure in very select patients with a favorable lesion location, but that thoracoscopic biopsy remains undisputed. They said more cases are needed to confirm a low risk of tumor seeding.

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: case report (single patient)
• Who was studied: One 73-year-old man treated at IRCCS-Arcispedale Santa Maria Nuova, Italy; no dates of care given (article received 2013)
• Exposure: The patient was reported to have no tobacco or asbestos exposure; no fiber type is discussed
• Main results:
  • CT showed a 43-mm by 28-mm right pleural mass in the right costovertebral recess adjacent to the carina; PET showed uptake with SUVmax 14.1 at the mass
  • EBUS-TBNA with a 22-gauge needle obtained adequate tissue from the pleural mass; three passes were made because no on-site cytopathologist was available
  • No complications were seen; the patient was observed for one hour in recovery and the following 12 hours
  • Tumor cells strongly expressed mesothelial markers (calretinin, CK5/6, WT-1), not BerEP4 or CEA, and did not express TTF-1, supporting epithelioid-type malignant mesothelioma infiltrating the lung
  • After radical surgical resection of the mass with the entire parietal pleura, the definitive pathological examination confirmed epithelioid malignant pleural mesothelioma
  • The postoperative course was unremarkable and the patient received adjuvant platinum-based chemotherapy
• The authors' conclusion: The authors concluded that EBUS-TBNA is a valid diagnostic procedure for MPM in very select patients with a favorable location of pleural thickening, while the role of thoracoscopic pleural biopsy remains undisputed because it also allows staging and immediate palliative treatment
• Limitations the authors state:
  • More cases are needed to confirm the low risk of tumor seeding with EBUS-TBNA
  • Thoracoscopic biopsy retains advantages: it can stage the disease and allow immediate palliative treatment (pleurodesis)

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Ultrasound, Pleural Thickening, Pleural Effusion, Pleural Biopsy, Epithelioid.

Related studies

• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

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