Endoscopic diagnosis and management of pleural effusion in malignant pleural mesothelioma

Our plain-English summary of Endoscopic diagnosis and management of pleural effusion in malignant pleural mesothelioma, by P. Ceruti, S. Lonni, F. Baglivo, et al (Journal of Thoracic Disease, 2018).

The study

• Authors: P. Ceruti, S. Lonni, F. Baglivo, G. Marchetti
• Journal: Journal of Thoracic Disease
• Published: 2018;10(Suppl 2):S269-S275
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an asbestos-related aggressive tumor, that requires proper diagnosis and management. Symptoms are nonspecific and chest computed tomography (CT) and chest ultrasound (US) are important radiological tools in the initial workup to identify early pathological signs. Performing a medical thoracoscopy (MT) is essential for a definitive diagnosis of MPM. The procedure, integrated with a prior US, allows a global evaluation of the pleural cavity and the execution of multiple targeted biopsies, with low risk of complications. Some different endoscopic patterns are recognized. Thoracoscopic biopsies provide enough material to allow a thorough pathological and immunohistochemical characterization. The presence of extensive pleural adhesions and critical patient conditions are the only absolute contraindications. The clinical course of MPM is characterized by chronic symptoms such as chest pain and progressive dyspnea, the latter caused mainly by recurrent pleural effusion. Palliative interventions are required in order to relieve symptoms and improve the quality of life (QoL). These include thoracentesis, pleurodesis and the placement of an indwelling pleural catheter.

In plain English

This article was a review, not a study of patients, and it reported no new patient data. The authors, from Brescia, Italy, described how malignant pleural mesothelioma (MPM), which they called an asbestos-related tumor, is diagnosed by medical thoracoscopy. In this procedure a lung specialist looks inside the chest through a small cut, under local anesthesia and moderate sedation. They also described how fluid that builds up around the lung (pleural effusion) is managed. Drawing on published work, they described three main appearances of MPM seen through the scope: multinodular, pachypleuritis (diffuse thickening) and nonspecific. They noted that fibrohyaline plaques indicate previous asbestos exposure and are often associated with MPM. Citing a published guideline, they gave an estimated death rate for the procedure of 0.34%. They described thoracentesis, pleurodesis and indwelling pleural catheters as options for controlling the fluid, and wrote that talc is considered the best agent for pleurodesis in terms of success rate. The authors concluded that a definitive diagnosis can be achieved by medical thoracoscopy, which they called a low risk procedure.

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 article on the diagnosis of malignant pleural mesothelioma by medical thoracoscopy and the management of pleural effusion; no original patient data
• Exposure: No exposure was studied. The review mentions asbestos exposure as the main cause of MPM, without naming fiber types.
• Main results:
  • The review described three main patterns of how MPM looks during thoracoscopy, citing earlier studies: multinodular, pachypleuritis and nonspecific
  • Fibrohyaline plaques seen during thoracoscopy were described, citing earlier studies, as indicating previous asbestos exposure and often being associated with MPM
  • Citing a published guideline, the review gave an estimated mortality rate of 0.34% for medical thoracoscopy
  • The absence of a pleural space, as with extensive pleural adhesions or previous pleurodesis, was described as the only absolute contraindication to medical thoracoscopy
  • Options described for managing pleural effusion were thoracentesis, pleurodesis or an indwelling pleural catheter. Citing a guideline, talc was described as the best sclerosant for pleurodesis in terms of success rate.
• The authors' conclusion: The authors concluded that, supported by imaging, a definitive diagnosis of MPM can be achieved by medical thoracoscopy, which they described as a low risk procedure. They also stated that talc pleurodesis is the most popular way to control recurrent effusion and that indwelling pleural catheters have become suitable alternatives.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleural Mesothelioma, Ultrasound, Medical Thoracoscopy, Pleural Cavity, Dyspnea, Palliative Care, Quality of Life.

Related studies

• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)
• Simultaneous Use of Endobronchial and Endoscopic Ultrasound Guidance as Primary Tools in the Diagnosis of Malignant Pleural Mesothelioma — B. Mankidy, J. Sparkman, et al. (2022)
• Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial — V.W. Rusch, R. Figlin, et al. (1991)
• The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions — O. Genc, M. Petrou, et al. (2000)
• Tetracycline sclerosis in the management of malignant pericardial effusion — F.A. Shepherd, J.S. Ginsberg, et al. (1985)
• Malignant pleural effusion and algorithm management — K. Zarogoulidis, P. Zarogoulidis, et al. (2013)

Browse more research in Journal of Thoracic Disease, or return to medical research.