Effusion cytology after extrapleural pneumonectomy for treatment of malignant mesothelioma

Our plain-English summary of Effusion cytology after extrapleural pneumonectomy for treatment of malignant mesothelioma, by A.A. Renshaw, D. Nappi, S. Swanson, et al (American Journal of Clinical Pathology, 1997).

The study

• Authors: A.A. Renshaw, D. Nappi, S. Swanson, D.J. Sugarbaker
• Journal: American Journal of Clinical Pathology
• Published: 1997;107(2):206-10
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Extrapleural pneumonectomy to treat malignant mesothelioma may offer a significant survival advantage for selected patients. The role of effusion cytology in these patients has not been previously examined. To evaluate this, cytology, pathology, and medical records of 26 cases in 21 patients who underwent extrapleural pneumonectomy because of malignant mesothelioma were reviewed. Positive cytologic results were noted on average 13 months later than negative results. Recurrence was most common in the peritoneum, followed by the ipsilateral thorax and contralateral thorax. Five of 11 true-negative results were secondary to infection; cytologic analysis revealed neutrophils in each case. Four of 5 false-negative cases were from the ipsilateral thorax, and no mesothelial cells were found. When these 4 cases are excluded, the sensitivity of cytologic examination in this setting was 91%, and specificity was 100%. Effusion cytology in patients after extrapleural pneumonectomy is an effective means of diagnosing recurrent malignant mesothelioma.

In plain English

This study reviewed records at Brigham and Women's Hospital, Boston, of patients who had extrapleural pneumonectomy, a lung-removal operation, for malignant mesothelioma between July 1987 and February 1996. The authors examined 26 effusion cytology cases from 21 patients, 17 men and 4 women. Asbestos exposure was not reported. There were 10 true-positive cases from 9 patients and no false-positive cases. In the true-positive cases, recurrence was in the peritoneum in 7, the same side of the chest in 2, and the opposite side in 1. Of 11 true-negative cases, 5 involved culture-proved infections. Of 5 false-negative cases, 4 came from the operated side of the chest and contained mainly blood or neutrophils, with no mesothelial cells. Overall sensitivity was 67% (10 of 15 cases). It was 91% when those 4 cases were excluded. Specificity was 100%. The authors concluded that effusion cytology after this operation is an effective means of diagnosing recurrent disease, especially in the peritoneum. They suggested that routine examination of fluid from the operated side of the chest is not a reliable means of diagnosing recurrence.

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: Retrospective review of hospital pathology, cytology and medical records (case series)
• Who was studied: 26 effusion cytology cases from 21 patients (17 men, 4 women; age at surgery 40 to 69 years, mean 56) who had extrapleural pneumonectomy for malignant mesothelioma at Brigham and Women's Hospital, Boston, between July 1987 and February 1996. All postoperative effusion specimens for each case were reviewed.
• Exposure: Not reported. The article gives no information on asbestos or other exposures. It studied cytology of fluid collections after extrapleural pneumonectomy.
• Main results:
  • 10 true-positive cases from 9 patients, and no false-positive cases
  • Among the true-positive cases, recurrence was in the ipsilateral thorax (same side as surgery) in 2, the contralateral thorax in 1, and the peritoneum in 7
  • Among 11 true-negative cases from 7 patients, 5 cases had culture-proved infections: one with biopsy findings consistent with empyema, and 4 others from 2 patients
  • There were 5 false-negative cases from 4 patients. In the 4 from the ipsilateral thorax, the specimen was mainly blood or neutrophils and no mesothelial cells were seen
  • Overall sensitivity was 67% (10 of 15 cases). Sensitivity was 91% when the 4 ipsilateral chest cases without mesothelial cells were excluded
  • Specificity was 100%
  • Mean time from surgery to effusion examination was 8 months for true-negative cases, 21 months for true-positive cases and 11 months for false-negative cases. The authors reported considerable overlap, so timing could not distinguish recurrence from no relapse
  • The authors suggested that, because of poor sensitivity, routine examination of fluid from the ipsilateral (operated-side) chest at any time after surgery is not a reliable means of diagnosing recurrent disease, and that routine thoracentesis may not adequately sample this space
• The authors' conclusion: The authors concluded that effusion cytology in patients who have had extrapleural pneumonectomy for malignant mesothelioma is an effective means of diagnosing recurrent disease, especially disease in the peritoneum

Topics

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

Medical terms in this study, explained in our Lexicon: Cytology, Extrapleural Pneumonectomy (EPP), Malignant Mesothelioma, Pathology, Peritoneum, Thorax, Mesothelial Cells.

Related studies

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• Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma — D.J. Sugarbaker, S.J. Mentzer, et al. (1992)
• Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience — P. Loveland, M. Christie, et al. (2018)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Tokunaga, M. Higashiyama, et al. (2011)

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