Current Opinion in Pulmonary Medicine

Our medical research library holds 40 studies published in Current Opinion in Pulmonary Medicine (1995–2025). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 38 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Lippincott Williams & Wilkins
• Published: 1995 to the present, United States
• Language: English
• ISSN: 1070-5287 (print), 1531-6971 (electronic)
• Its record in the NLM Catalog

2020s

• Bedside to bench and back again-translational research in interventional pulmonology. B. Iqbal, H.J. Choi, N.I. Kanellakis, et al. 2025;31(1):59-64. Review PubMed · Publisher · Free full text

  Abstract

  Purpose Of Review: Translational research in Interventional Pulmonology has made significant advances in recent years, ranging from novel biomarkers and imaging to practice-changing clinical trials in lung cancer and pleural disease. This review article aims to summarize key research studies in the field to understand the latest published evidence and to highlight areas of growing academic interest.

  Recent Findings: In lung cancer, the role of novel imaging and biomarkers and their potential utility in early lung cancer diagnosis will be highlighted. In pleural disease, less invasive/conservative treatment in pneumothorax, early aggressive treatment in pleural infection along with novel biomarkers, and the shift beyond drainage strategies in malignant pleural effusion and mesothelioma will be discussed.

  Summary: This overview of translational research in the field of interventional pulmonology will ultimately help to highlight the gaps in current evidence to promote research in areas of clinical significance.

  Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

• Asbestos-associated pulmonary disease. J.D. Caceres, A.N. Venkata. 2023;29(2):76-82. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Exposure to asbestos can cause both benign and malignant, pulmonary and pleural diseases. In the current era of low asbestos exposure, it is critical to be aware of complications from asbestos exposure; as they often arise after decades of exposure, asbestos-related pulmonary complications include asbestosis, pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions and malignant pleural mesothelioma.

  Recent Findings: Multiple recent studies are featured in this review, including a study evaluating imaging characteristics of asbestos with other fibrotic lung diseases, a study that quantified pleural plaques on computed tomography imaging and its impact on pulmonary function, a study that examined the risk of lung cancer with pleural plaques among two large cohorts and a review of nonasbestos causes of malignant mesothelioma.

  Summary: Asbestos-related pulmonary and pleural diseases continue to cause significant morbidity and mortality. This review summarizes the current advances in this field and highlights areas that need additional research.

  Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

• Editorial: Silicosis, asbestos-related diseases, war-site exposures and a variety of topics in chronic obstructive pulmonary disease. M. Joshi, B. Varkey. 2023;29(2):61-62. Editorial PubMed · Publisher

2010s

• Advances in pathological diagnosis of mesothelioma: what pulmonologists should know. A. Louw, A. Badiei, J. Creaney, et al. 2019;25(4):354-361. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Malignant pleural mesothelioma (MPM) is a universally fatal illness with a rising incidence, particularly in developing countries. The diagnosis can be challenging and require repeated investigations with implications for the patient and healthcare system.

  Recent Findings: Distinguishing between benign/reactive and malignant mesothelial proliferations can be challenging. Cytological diagnosis of MPM from pleural fluid is as reliable as histological analysis of tissue biopsies in epithelioid MPM - an approach endorsed by the International Academy of Cytology. Identification of BRCA1-associated protein 1 (BAP1) and cyclin-dependent kinase inhibitor 2A (CDKN2A) gene mutations in MPM have led to the development of new ancillary tests that can streamline the diagnostic pathway. The prognostic values of these molecules are being investigated. Clinicians should be aware of the recently described BAP1 tumor predisposition syndrome and offer genetic investigations in potential patients. Routine use of prophylactic radiotherapy in MPM patients after pleural interventions has been disproved in a randomized trial.

  Summary: Diagnosis of epithelioid MPM can be established on pleural fluid analysis in most patients. The use of BAP1 immunostaining and CDKN2A/p16 fluorescence in-situ hybridization are particularly useful in distinguishing benign from malignant mesothelial proliferations. Clinicians should ensure these investigations are available in the pathological assessment of cases to minimize invasive investigations and the associated risks.

• Updates in the diagnosis and treatment of malignant pleural mesothelioma. D. Katzman, D.H. Sterman. 2018;24(4):319-326. Review PubMed · Publisher

  Abstract

  Purpose Of Review: This review article describes current diagnostic and treatment modalities for malignant pleural mesothelioma (MPM).

  Recent Findings: Few randomized trials in MPM have demonstrated improved survival with current therapies. A randomized trial of first-line chemotherapy with and without bevacizumab in unresectable MPM is the only randomized trial of a new treatment regimen to demonstrate a survival benefit since cisplatin with pemetrexed became the standard of care for unresectable MPM in 2003. Unfortunately, in unresectable MPM, first-line chemotherapy alone or in combination with bevacizumab has demonstrated only limited improvements in overall survival. Recently, in nonrandomized observational studies, multimodality treatments with chemotherapy, surgery, radiation, and novel therapies have been associated with prolonged survival in select patients. Currently, there are no FDA approved second-line therapies, and clinical trial enrollment is recommended for second-line treatment.

  Summary: MPM remains difficult to treat and has an overall poor prognosis despite current multimodality treatment. Thoracoscopy with multiple pleural biopsies can provide adequate tissue specimens for diagnostic testing to distinguish histologic MPM subtypes and perform molecular profiling, which influence prognosis and treatment options. In early clinical trials, immunotherapies and therapies directed against cancer-associated antigens and oncogenic alterations are emerging as promising future treatments.

• Prophylactic radiotherapy for procedure tract metastases in mesothelioma: a review. D.T. Arnold, A.O. Clive. 2017;23(4):357-364. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Malignant pleural mesothelioma is an aggressive malignancy with a very poor prognosis. The majority of patients require pleural procedures for diagnostic or fluid management purposes. Damage to the pleura during these procedures can lead to procedure tract metastases (PTMs), with increasing risk from larger interventions. Prophylactic radiotherapy to these sites is a controversial topic with conflicting results from trial data. In this review, we summarize the recent evidence.

  Recent Findings: Four RCTs have been published on this topic, with another in follow-up. The earliest, from a cohort of 40 patients, strongly advocated the use of prophylactic radiotherapy. More recent trials, most notably the Surgical and large bore procedures in Malignant pleural mesothelioma And Radiotherapy Trial (SMART) (which randomized over 200 patients) did not demonstrate any benefit, especially when patient report symptoms and cost-effectiveness are considered. Certain subgroups demand further investigation, such as those not receiving systematic chemotherapy or with surgical intervention sites. The soon to be published Prophylactic Irradiation of Tracts (PIT) trial may help to further clarify best practice.

  Summary: Recent studies have shown that prophylactic radiotherapy should not be routinely used to prevent PTMs in mesothelioma. Instead patients should undergo careful clinical follow-up to ensure PTMs are identified and treated promptly to minimize symptoms.

• Surgery as part of radical treatment for malignant pleural mesothelioma. D.A. Waller, S. Tenconi. 2017;23(4):334-338. Review PubMed · Publisher

  Abstract

  Purpose Of Review: To review the latest developments in surgery for malignant pleural mesothelioma both in patient selection, surgical technique, and strategy.

  Recent Findings: The International Association for the Study of Lung Cancer mesothelioma staging project has produced data to inform the 8th tumour node metastasis revision. The difficulty in clinical N staging and clinical T staging are highlighted and the importance of tumour volume is recognized. New imaging techniques can be utilized to assess tumour volume. The transition from extrapleural pneumonectomy to lung-sparing pleurectomy/decortication has extended the role of cancer-directed surgery into a more elderly population. More aggressive multimodality regimes, including induction radiotherapy are available to a selected population and adjuvant radiotherapy and chemotherapy are feasible in the elderly majority. Additional chemotherapy should not be delayed in those with poorer prognosis node positive, nonepithelioid disease.

  Summary: Radical surgery for malignant pleural mesothelioma can achieve significant survival when targeted in those with the best prognosis by careful staging. It can be made more accessible by lung preservation without compromising outcome. It should be part of multimodality therapy.

• Asbestosis and environmental causes of usual interstitial pneumonia. M. Gulati, C.A. Redlich. 2015;21(2):193-200. Review PubMed · Publisher · Free full text

  Abstract

  Purpose Of Review: Recent epidemiologic investigations suggest that occupational and environmental exposures contribute to the overall burden of idiopathic pulmonary fibrosis (IPF). This article explores the epidemiologic and clinical challenges to establishing exposure associations, the current literature regarding exposure disease relationships and the diagnostic work-up of IPF and asbestosis patients.

  Recent Findings: IPF patients demonstrate a histopathologic pattern of usual interstitial pneumonia. In the absence of a known cause or association, a usual interstitial pneumonia pattern leads to an IPF diagnosis, which is a progressive and often terminal fibrotic lung disease. It has long been recognized that asbestos exposure can cause pathologic and radiographic changes indistinguishable from IPF. Several epidemiologic studies, primarily case control in design, have found that a number of other exposures that can increase risk of developing IPF include cigarette smoke, wood dust, metal dust, sand/silica and agricultural exposures. Lung mineralogic analyses have provided additional support to causal associations. Genetic variation may explain differences in disease susceptibility among the population.

  Summary: An accumulating body of literature suggests that occupational and environmental exposure can contribute to the development of IPF. The impact of exposure on the pathogenesis and clinical course of disease requires further study.

• Comparison of mesothelin and fibulin-3 in pleural fluid and serum as markers in malignant mesothelioma. J. Creaney, I.M. Dick, B.W. Robinson. 2015;21(4):352-6. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Malignant mesothelioma is an asbestos-induced, aggressive tumour, which frequently presents with pleural effusion. There are over 60 reported causes that can result in the development of a pleural effusion. Currently, there are no tumour biomarkers in widespread clinical use for the differential diagnosis of mesothelioma from other diseases. With the incidence of mesothelioma expected to continue to increase, it is timely to review the current status of effusion-based biomarkers for mesothelioma diagnosis.

  Recent Findings: The majority of recent studies have evaluated soluble mesothelin in effusions in a diagnostic setting for mesothelioma. However, at high specificity, the sensitivity of the assay is limited to approximately 60% at the time of diagnosis. There is considerable research effort directed toward the identification of new markers for mesothelioma through a variety of genomic, proteomic and immunomic based platforms. One of the few new biomarkers to be identified through a biomarker discovery pipeline and evaluated in pleural effusions is fibulin-3. Preliminary results on the diagnostic accuracy of fibulin-3 have been inconsistent.

  Summary: To date, soluble mesothelin remains the best available biomarker for mesothelioma and a positive result is clinically useful in patients with pleural effusions in whom the diagnosis is uncertain.

• Global perspectives of emerging occupational and environmental lung diseases. S. Moitra, R. Puri, D. Paul, et al. 2015;21(2):114-20. Review PubMed · Publisher

  Abstract

  Purpose Of Review: New technologies continue to be introduced into the workplace and the environment. These novel technologies also bring in new hazards leading to evolving patterns of established occupational and environmental diseases, as well as novel conditions never before encountered.

  Recent Findings: Many of these emerging conditions have appeared in media outlets or in the literature as case reports. These sentinel cases often serve as a warning sign for subsequent outbreaks. This review will discuss environmental and occupational lung diseases and exposures from a global perspective. These diseases and exposures include environmental exposure to asbestos and lung diseases, accelerated silicosis in sandblasting jean workers, coal worker's pneumoconiosis in surface coal miners, health effects of indoor air pollution from burning of biomass fuels and exposures to heavy metals and potential health effects from hydraulic fracturing (fracking). Other emerging conditions are also discussed, including smog in developing countries, sand storms in Asia and the Middle East and respiratory illnesses from nanoparticles and man-made fibres.

  Summary: Clinicians must remain vigilant for potential occupational and environmental exposures, especially when evaluating patients with unusual and unique presentation, so that occupational and environmental risk factors may be identified, and monitoring and preventive measures can be implemented early.

• Environmental exposure to asbestos: from geology to mesothelioma. M. Bayram, N.D. Bakan. 2014;20(3):301-7. Review PubMed · Publisher

  Abstract

  Purpose Of Review: This article aims to review the geological background of environmental asbestos exposure and the distribution of asbestos-related disease (ARD) in association with naturally occurring asbestos (NOA), and discusses the potential health risks associated with exposure to non-occupational asbestos.

  Recent Findings: With the motion of continental and oceanic plates, in some parts of the world serpentinites in the lower layer of the oceanic plate move into the continental plate and form the so-called ophiolites. Ophiolites consist of soil and rocks containing serpentine-type asbestos. There is an increase in ARDs in regions close to ophiolites. Indoor exposure and outdoor exposure to NOA, outdoor exposure to industrial asbestos and mines, urbanization and construction works in NOA regions are the known sources and types of environmental asbestos exposure.

  Summary: Although there is an expectance of decline in ARDs caused by industrial exposure to asbestos, the environmental exposure to asbestos is still a challenge waiting to be overcome.

• Man-made mineral fibers and interstitial lung diseases. E. Fireman. 2014;20(2):194-8. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Manufactured (artificial) fibers represent an important and continuously growing volume among substitutes to natural fibers. A major proportion of the population in an industrialized society has been, is, or will be in contact with these fibers. The fibrous configuration of asbestos is well recognized as being an important parameter in toxicity, and now that of synthetic fibers is also suspected of inducing serious health effects on the respiratory system. There is an ongoing debate about the actual fibrogenic effect of these man-made mineral fibers (MMMFs) in humans.

  Recent Findings: Several case reports have demonstrated the biopersistance of MMMFs in the lung of workers who were exposed to rock wool or fiberglass for long periods of time and were diagnosed with interstitial pulmonary fibrosis. A 20-year follow up also identified refractory ceramic fibers in workers' lung tissue, with significant association between cumulative fiber exposure and radiographic pleural changes. Newly emerging man-made fiber industries appear to induce new types of occupational diseases.

  Summary: Exposure of workers in MMMFs production plants is correlated to high risk for developing pneumoconiosis. Large epidemiological studies are needed in order to determine dose metrics for risk assessment and management.

• The health risk of chrysotile asbestos. D.M. Bernstein. 2014;20(4):366-70. Review PubMed · Publisher

  Abstract

  Purpose Of Review: The word asbestos is a poorly attributed term, as it refers to two very different minerals with very different characteristics. One is the serpentine mineral of which the white asbestos, chrysotile, is the most common. The other is the amphibole asbestos, which includes the blue asbestos crocidolite and the brown asbestos amosite. Although today chrysotile is the only type used commercially, the legacy of past use of amphibole asbestos remains. This review clarifies the differences between the two mineral families referred to as asbestos and summarizes the scientific basis for understanding the important differences in the toxicology and epidemiology of these two minerals.

  Recent Findings: Biopersistence and sub-chronic inhalation toxicology studies have shown that exposure to chrysotile at up to 5000 times the current threshold limit value (0.1 fibers/cm) produces no pathological response. These studies demonstrate as well that following short-term exposure the longer chrysotile fibers rapidly clear from the lung and are not observed in the pleural cavity. In contrast, short-term exposure to amphibole asbestos results quickly in the initiation of a pathological response in the lung and the pleural cavity.

  Summary: Significant progress has been made in understanding the factors that influence inhalation toxicology studies of fibers and epidemiological studies of workers. Evaluation of the toxicology and epidemiology studies of chrysotile indicates that it can be used safely under controlled use. In contrast, even short-term exposure to amphibole asbestos can result in disease.

• Mortality in chrysotile asbestos workers in China. X. Wang, M.N. Courtice, S. Lin. 2013;19(2):169-73. Review PubMed · Publisher

  Abstract

  Purpose Of Review: China has been the world's top chrysotile asbestos consumer and producer. However, the national mortality rate for asbestos-related diseases, particularly from malignancies, is unknown. This review elaborates recent studies on cancer mortality and nonmalignant respiratory diseases in Chinese chrysotile asbestos workers.

  Recent Findings: Studies conducted in asbestos products factory workers and miners have demonstrated strong associations between exposure to chrysotile and mortality rates for lung cancer and nonmalignant respiratory diseases. Mortality rates for lung cancer and nonmalignant respiratory diseases in both asbestos workers and miners are four and three times higher, respectively, than expected, which are greater than those seen in studies from western countries, likely a reflection of heavier exposures and less effective protection for workers. An increased risk of gastrointestinal cancer was also detected in chrysotile miners. There have been surprisingly few reported cases of mesothelioma, however, which could, at least partially, indicate a problem in diagnosis.

  Summary: Given the substantially increased death risks for lung cancer and nonmalignant respiratory diseases, urgent efforts must be made to implement occupational health and safety regulations and decrease workers' exposures to prevent a future heavier disease burden. Meanwhile, improvements in diagnostics and systematic recording of the incidence and mortality of asbestos-related diseases are needed.

• Asbestos-related pleural disease. R. Myers. 2012;18(4):377-81. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Asbestos exposure is the cause of significant pleural disease - both benign and malignant. Although there is increased awareness, individuals continue to be exposed, and we will continue to see its sequelae for years to come because of the delay between exposure and disease manifestation. Asbestos-related pleural disease includes pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions (BAPEs), and malignant pleural mesothelioma (MPM).

  Recent Findings: Several recent studies are highlighted throughout this review, including a comparative analysis of diagnostic imaging modalities for identifying and characterizing pleural plaques, the effect of pleural plaques on lung volumes and flows, and how pain is a relatively common feature in patients with pleural plaques. Advances in the treatment of MPM are limited, but a recent publication highlights the increased morbidity associated with surgical debulking procedures and questions the benefit of these procedures.

  Summary: Asbestos-related pleural disease will continue to present a significant burden of illness. Recent publications have suggested potential treatment benefit and point to areas that would require further investigation.

• Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases. V.C. Antao, T.C. Larson, D.K. Horton. 2012;18(2):161-7. Review PubMed · Publisher · Free full text

  Abstract

  Purpose Of Review: The vermiculite ore formerly mined in Libby, Montana, contains asbestiform amphibole fibers of winchite, richterite, and tremolite asbestos. Because of the public health impact of widespread occupational and nonoccupational exposure to amphiboles in Libby vermiculite, numerous related studies have been published in recent years. Here we review current research related to this issue.

  Recent Findings: Excess morbidity and mortality classically associated with asbestos exposure have been well documented among persons exposed to Libby vermiculite. Excess morbidity and mortality have likewise been documented among persons with only nonoccupational exposure. A strong exposure-response relationship exists for many malignant and nonmalignant outcomes and the most common outcome, pleural plaques, may occur at low lifetime cumulative exposures.

  Summary: The public health situation related to Libby, Montana, has led to huge investments in public health actions and research. The resulting studies have added much to the body of knowledge concerning health effects of exposures to Libby amphibole fibers specifically and asbestos exposure in general.

• Shattered lives: asbestos-related diseases. S. Sharma. 2012;18(4):375-6. Editorial PubMed · Publisher

• Outcome of patients with nonspecific pleuritis at thoracoscopy. J.M. Wrightson, H.E. Davies. 2011;17(4):242-6. Review PubMed · Publisher

  Abstract

  Purpose Of Review: The histological finding of pleural inflammation (pleuritis/fibrosis) is frequently found in pleural biopsies taken at thoracoscopy. This is a nonspecific finding, representing a common endpoint of many pleural conditions. Additional features, such as malignant cells, caseating granulomas and evidence of vasculitis, are required to make an aetiological histological diagnosis; in the absence of these features, the term 'nonspecific pleuritis/fibrosis' (NSP) is used. The cause of NSP is obscure and presents a particular dilemma: whether this apparently benign result represents a 'false-negative' sampling error in malignancy.

  Recent Findings: In a recent longitudinal follow-up study of 142 patients undergoing thoracoscopy, NSP was found in 31%. Of these, a likely cause for the NSP was found in 38% and malignancy occurred in 12%. These data were consistent with previous studies.

  Summary: NSP is a histological diagnosis made in approximately 30-40% of patients with an undiagnosed exudative pleural effusion. The majority of cases adopt a benign course, although 8-12% may be subsequently found to have malignancy, particularly mesothelioma. In 25-91% no cause for the NSP is found; these patients are considered to have 'idiopathic pleuritis'. Prolonged follow-up, with occasionally further (usually more invasive) biopsies, is essential to rule out malignancy.

• The diminishing role of surgery in pleural disease. H.E. Davies, A. Rosenstengel, Y.C. Lee. 2011;17(4):247-54. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Pleural disease is common. Traditionally, many patients were subjected to surgery for diagnosis and treatment. Most pleural surgical procedures have not been subjected to high-quality clinical appraisal and their use is based on anecdotal series with selection bias. The evidence (or the lack) of benefits of surgery in common pleural conditions is reviewed.

  Recent Findings: Recent studies do not support the routine therapeutic use of surgery in patients with malignant pleural effusions, empyema or mesothelioma. Four randomized studies have failed to show significant benefits of thoracoscopic poudrage over bedside pleurodesis. Surgery as first-line therapy for empyema was studied in four randomized studies with mixed results and no consistent benefits. Cumulative evidence suggests that radical surgery in mesothelioma, especially extrapleural pneumonectomy, is not justified. Advances in imaging modalities and histopathological tools have minimized the need for surgery in the workup of pleural effusions. Complications associated with surgery are increasingly recognized.

  Summary: Surgery has associated perioperative risks and costs, and residual pain is not uncommon. Many conventional pleural surgeries have not been assessed in randomized studies. Pulmonologists should be aware of the evidence that supports surgical interventions, or the lack of it, in order to make informed clinical decisions and optimize patient care.

• Parenchymal and airway diseases caused by asbestos. A.L. Antonescu-Turcu, R.M. Schapira. 2010;16(2):155-61. Review PubMed · Publisher

  Abstract

  Purpose Of Review: The extensive industrial use of asbestos for many decades has been linked to development of benign and malignant pleuropulmonary disease. This review summarizes newer evidence and ongoing controversies that exist in the literature regarding asbestos-related parenchymal and airway diseases.

  Recent Findings: Asbestosis represents a significant respiratory problem despite the improvement in the workplace hygiene and a decrease in use of asbestos. The management of asbestosis remains challenging as currently there is no specific treatment. The role of asbestos exposure alone as a cause of chronic airway obstruction remains uncertain. The relationship between lung cancer and asbestos exposure alone and in combination with smoking has also been investigated. The benefit of screening for asbestos-related pleuropulmonary disease remains uncertain as does the use of computed tomography scanning for the purpose of screening.

  Summary: Future studies will help clarify the clinical issues and shape screening strategies for asbestos-exposed individuals.

2000s

• Serum and pleural fluid biomarkers for mesothelioma. J. Creaney, B.W. Robinson. 2009;15(4):366-70. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Malignant mesothelioma is an asbestos-induced, aggressive tumour. In centres across the world, research has focused on evaluating biomarkers for malignant mesothelioma screening, diagnosis, prognostication and monitoring. With the incidence of malignant mesothelioma expected to increase, it is timely to review the current status of biomarkers in this field.

  Recent Findings: The majority of recent studies have evaluated the commercial MESOMARK assay in a diagnostic setting. Studies have clarified that soluble-shed mesothelin as well as mesothelin-related peptide are targets of the assay. The assay sensitivity ranges from 50% at diagnosis to 84% in advanced disease. The assay has a high level of specificity relative to benign lung and pleural conditions and is positive in 10-15% of other malignancies. In a prospective screen of 538 asbestos-exposed workers, 2.8% were positive; one had lung cancer that was subsequently successfully treated. The biomarkers megakaryocyte potentiating factor, osteopontin and CA125, either alone or in combination with soluble mesothelin, have also been assessed.

  Summary: To date, soluble mesothelin remains the best available biomarker for malignant mesothelioma. However, a lack of sensitivity for early-stage disease and for all malignant mesothelioma histologies provides motivation for the search of novel malignant mesothelioma biomarkers with greater sensitivity, especially for very early disease.

• Malignant mesothelioma 2008. M.D. Zervos, C. Bizekis, H.I. Pass. 2008;14(4):303-9. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Mesothelioma is an aggressive malignancy of the pleura with poor survival. There will be approximately 3000 cases of mesothelioma in the United States annually. Multimodality treatment including neoadjuvant chemotherapy in selected individuals followed by extrapleural pneumonectomy and radiation has been studied in recent trials for its effects on disease free and overall survival This review provides a general overview of malignant mesothelioma with a summary of the most significant articles from within the past year as well as from the past.

  Recent Findings: Areas of recent interest include the evaluation of osteopontin and mesothelin as new tumor markers for mesothelioma. New phase III trials have been performed to evaluate the use of combined chemotherapy regimens.

  Summary: Malignant mesothelioma is a very difficult malignancy to treat. Patients with the disease usually have an occupational asbestos exposure, and in some, viral exposure with SV40. There have been many historical treatments including combinations of local control with surgery and radiation as well as attempts to prevent systemic failure with chemotherapy. Novel therapies including intrapleural chemotherapy, photodynamic therapy and hyperthermic perfusion have also been used with some success. Finally there are several attempts at immunomodulating and targeted treatments, which are in phase I/II trials.

• The relationship between simian virus 40 and mesothelioma. Z. Rivera, O. Strianese, P. Bertino, et al. 2008;14(4):316-21. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Simian virus 40 is present in some human malignant mesotheliomas. The evidence in favor and against a pathogenic role of simian virus 40 in malignant mesothelioma is discussed in this review.

  Recent Findings: When simian virus 40 is injected intracardially into hamsters, 60% develop and die of malignant mesothelioma. Moreover, some human malignant mesotheliomas contain and express simian virus 40 DNA and proteins. To date, over 50 laboratories have detected simian virus 40 in malignant mesotheliomas and in other tumors; however, the variability of the percentage of positivity led to a controversy about the role and significance of simian virus 40 in malignant mesotheliomas. Compared with other cell types, human mesothelial cells are unusually susceptible to simian virus 40-induced malignant transformation. The presence of simian virus 40 in malignant mesothelioma has been associated with the activation of specific oncogene pathways. Cocarcinogenesis between simian virus 40 and asbestos in causing malignant mesotheliomas has been demonstrated in three separate research laboratories using different experimental approaches. Epidemiological data possibly linking simian virus 40 and malignant mesothelioma is lacking owing to unattainable identification of infected from noninfected cohorts.

  Summary: Available evidence appears sufficient to link simian virus 40 either alone or in conjunction with asbestos in causing malignant mesotheliomas; however, it is still insufficient to speculate about the contribution of simian virus 40 to the overall incidence of malignant mesotheliomas.

• Biomarkers for mesothelioma. A. Scherpereel, Y.C. Lee. 2007;13(4):339-443. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Mesothelioma is an incurable cancer and its global incidence continues to increase. There has been strong interest in the search for a biomarker that would be of value for the diagnosis, prognosis and disease monitoring of mesothelioma. Large series evaluating the use of novel candidate markers have recently been published.

  Recent Findings: To date, global gene profiling studies have failed to find a molecule that reliably captures all subtypes of mesothelioma, and differentiates it from benign pathologies and metastatic carcinomas. Soluble mesothelin-related peptide (SMRP), osteopontin and megakaryocyte potentiating factor have been assessed as markers. SMRP testing is clinically available and provides reasonable diagnostic sensitivity and specificity when applied to serum or pleural fluid. Elevated SMRP levels can occur in metastatic, especially ovarian and pancreatic, adenocarcinomas. False negatives are common with sarcomatoid mesothelioma. SMRP levels may reflect tumor load and disease progression. The role of SMRP in predicting mesothelioma development in subjects exposed to asbestos has raised interest. Osteopontin lacks specificity as a diagnostic marker for mesothelioma but may have value in disease monitoring.

  Summary: The proposed markers have insufficient accuracy to replace cytohistology as the gold standard for diagnosis for mesothelioma. Elevated SMRP levels raise suspicion of mesothelioma although negative values do not exclude disease. Its role in disease monitoring in patients and in predicting disease development in at-risk individuals warrant further study.

• The risk of mesothelioma from exposure to chrysotile asbestos. C.M. Yarborough. 2007;13(4):334-8. Review PubMed · Publisher

  Abstract

  Purpose Of Review: This review assesses the risk of developing diffuse malignant mesothelioma of the pleura from exposures to chrysotile fibers and contrasts it with the known risk of amphibole asbestos.

  Recent Findings: Although a rare cancer, the mortality rates of pleural mesothelioma continue to be significantly elevated because of past occupational exposures to airborne asbestos fibers. New analyses of occupational epidemiologic studies for highly exposed workers show a substantially lower potency and suggest an empiric threshold for chrysotile compared with amphibole asbestos. Important kinetic and pathological differences between chrysotile and amphiboles have been substantiated that support chrysotile's impotency in causing pleural mesothelioma.

  Summary: Excess risk of pleural mesothelioma from past exposures to asbestos, as evidenced by a trend of high incidence rates during the last half century, appears to be the result of nonchrysotile asbestiform fibers. Although scientific efforts and legal arguments continue, the risk of pleural mesothelioma in human populations is probably negligible for exposures to airborne chrysotile asbestos that is not known to be contaminated by amphibole. This distinction for asbestos fiber types is pivotal for understanding hazards and characterizing risks of continued use of natural chrysotile asbestos today and also new nanofibers.

• Pathogenesis of the eosinophilic pleural effusions. I. Kalomenidis, R.W. Light. 2004;10(4):289-93. Review PubMed · Publisher

  Abstract

  Purpose Of Review: Eosinophilic pleural effusions (EPE) are defined as those that contain at least 10% eosinophils. EPEs account for 5 to 16% of exudative pleural effusions. However, their pathogenesis is poorly understood. The purpose of this review is to discuss the mechanisms that lead to eosinophilic pleural inflammation.

  Recent Findings: Eosinophilic pleural effusions are caused by the presence of air or blood or both in the pleural space, infectious or other inflammatory diseases, malignancy, pulmonary emboli, asbestos exposure, and drug reactions. Differences in the clinical features suggest that a variety of mechanisms operate to induce eosinophilic pleural inflammation and pleural fluid accumulation. Human and animal studies indicate that interleukin (IL)-5 is an important common contributor of different pathogenetic pathways. The possible role of other cytokines, chemokines, and adhesion molecules in the development of EPE is under investigation.

  Summary: Understanding the pathogenesis of EPE will permit the development of novel therapies for the persistent, symptomatic, posttraumatic and idiopathic EPE. Anti-IL-5 treatment is an interesting option that requires further research.

• Benign asbestos pleural diseases. S.J. Chapman, W.O. Cookson, A.W. Musk, et al. 2003;9(4):266-71. Review PubMed · Publisher

  Abstract

  The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.

• Eosinophilic pleural effusions. I. Kalomenidis, R.W. Light. 2003;9(4):254-60. Review PubMed · Publisher

  Abstract

  Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion. No etiology is found in as many as one third of patients. Because studies evaluating different diagnostic approaches with eosinophilic pleural effusions are lacking, the authors suggest that certain noninvasive and invasive diagnostic tools must be used based on the patient's clinical characteristics.

• The molecular biology of lung cancer. J.A. Ross, G.D. Rosen. 2002;8(4):265-9. Review PubMed · Publisher

  Abstract

  Lung cancer is the result of molecular changes that occur in the cell, resulting in the deregulation of pathways which control normal cellular growth, differentiation, and apoptosis. Several of these pathways contain well-characterized proto-oncogenes and tumor suppressor genes which are found to be mutated or have abnormal expression patterns in lung cancer. The molecular changes that characterize lung cancer are complex, but it is known that cigarette smoking causes most squamous cell and small-cell carcinomas. However, the association between cigarette smoke and adenocarcinoma is less clear. Environmental factors, such as air pollutants, radon, and asbestos, likely contribute to the development of lung cancer. In this review, we discuss the major molecular abnormalities in lung cancer with a review of recent studies that begin to decipher the role that different tumor suppressor genes and oncogenes play in the pathogenesis of lung cancer. Also, we highlight the research that has identified new genes which may play a role in lung cancer pathogenesis or progression.

• Occupational and environmental causes of bronchogenic carcinoma. B.M. Haus, H. Razavi, W.G. Kuschner. 2001;7(4):220-5. Review PubMed · Publisher

  Abstract

  Occupational and environmental carcinogens account for an important minority of cases of bronchogenic carcinoma. From a public health perspective, it is important to characterize occupational and environmental carcinogens and to define disease risk to reduce preventable lung cancer. From a clinician's perspective, it is important to distinguish individual cases of occupational lung cancer from nonoccupational cases, because cancer acquired from work may be compensable through worker's compensation claims and litigation. Important carcinogens include asbestos, radon daughters, diesel exhaust, and metals. Epidemiologic investigations identify excess cases of lung cancer in populations exposed to carcinogens. Experimental animal and ex vivo human research provide complementary information supporting causal relationships between exposure and carcinogenesis. Clinical challenges include proving that a given case of lung cancer is due to an occupational exposure. Research challenges include determining safe exposure thresholds. Only a small percentage of all chemicals used in industry have been extensively analyzed for their carcinogenic potential. Scientific and regulatory information about pulmonary occupational and environmental health and safety is available from several important agencies and organizations, including the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, the International Agency for Research on Cancer, the American Lung Association, and the Environmental Protection Agency.

• Environmental asbestos exposure and mesothelioma. M.R. Orenstein, M.B. Schenker. 2000;6(4):371-7. Review PubMed · Publisher

  Abstract

  Epidemiologic studies of mesothelioma have focused primarily on occupational exposures to asbestos. Nonoccupational exposure to asbestos can be grouped into three main categories: paraoccupational (familial), neighborhood, and true environmental exposures. Elevated mesothelioma rates not attributable to occupational exposures have been observed in asbestos mining and manufacturing areas. Asbestos is one of the most dangerous environmental carcinogens because of the small dose known to cause mesothelioma and the rapid lethality of the disease once it develops. Further research is needed to characterize the contribution and risk profile for environmental asbestos and mesothelioma, and for the development of public health policy.

• Management of malignant pleural mesothelioma: a critical review. Y.C. Lee, R.W. Light, A.W. Musk. 2000;6(4):267-74. Review PubMed · Publisher

  Abstract

  Malignant mesothelioma remains a uniformly fatal disease and best supportive care continues to be the standard treatment. Neither chemotherapy nor surgery has been shown to prolong survival. Radiotherapy is not curative but is useful for prophylaxis against needle-track metastases and for symptom palliation. Combinations of therapies have been tried but most studies were uncontrolled and selection bias makes the results impossible to interpret. The combination of extrapleural pneumonectomy, chemotherapy, and radiotherapy attracted much interest, but the subsequent results were disappointing in a highly selected group of patients. Randomized controlled trials are desperately needed to provide definitive information on experimental treatments. It is also important to develop better measures of disease response and to assess quality of life issues in clinical trials. If patients are to receive therapies other than palliation, they should only do so in the setting of randomized controlled trials under approved protocols.

• Mesothelioma: new concepts in diagnosis and management. A.M. Boylan. 2000;6(2):157-63. Review PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma is an uncommon, but no longer rare, cancer that is frequently difficult to diagnose and poorly responsive to therapy. Because of the difficulties distinguishing mesothelioma from metastatic adenocarcinoma and reactive pleural inflammation, thoracoscopy or open lung biopsy are usually required to obtain adequate samples for pathologic evaluation. Staging of mesothelioma remains a controversial area. Because none of the six staging systems used in the past was found to be predictive, a TNM-based staging system was recently proposed and is awaiting universal acceptance. Generally perceived as a death sentence, this cancer is associated with a median survival of 9 months from the time of diagnosis in most series, but newer therapeutic strategies show promise for improved and even long-term survival in select cases. Randomized trials are awaited to determine if the improvements in survival reported are not simply due to patient selection.

• The past and present of pneumoconioses. P. De Vuyst, P. Camus. 2000;6(2):151-6. Review PubMed · Publisher

  Abstract

  Pneumoconioses are still a common cause of chronic lung disease. In industrialized countries, improvements in working conditions and dust control measures have led to a decrease in the incidence of severe forms of silicosis, coal worker pneumoconiosis, and parenchymal asbestosis. However, the diversity of settings in which silica and asbestos are used fuels a continued input of cases, and the burden of cases related to remote exposures is still considerable. Overall, the clinical picture of the classic pneumoconioses and their complications has not changed substantially. However, their limits and links have expanded toward systemic and connective tissue disease, idiopathic pulmonary fibrosis, and antineutrophil cytoplasmic autoantibody-positive vasculitides. Immunologically mediated occupational lung diseases have emerged, such as berylliosis and hard-metal disease. Advances in imaging, mineralogic analysis of bronchoalveolar lavage fluid, and immunologic techniques have been instrumental in describing new patterns of disease and are helpful in litigious or difficult cases.

1990s

• Pleural mesothelioma. P. Astoul. 1999;5(4):259-68. Review PubMed · Publisher

  Abstract

  The increasing incidence of malignant pleural mesothelioma (MPM), better knowledge of its pathogenesis with a strong implication of asbestos fibers, and some promising therapeutic results have led to a new interest in the management of patients with this disease. The diagnosis of MPM is easier because of new immunohistochemical markers that recognize the mesothelial cells with good specificity and sensitivity on pleural biopsy samples ideally obtained by thoracoscopy. Moreover, this endoscopic procedure allows the physician to make the diagnosis of MPM at an early stage, which is the key of the therapeutic management of this disease. If radiotherapy is necessary in preventing the malignant seeding after pleural procedures in patients, the lack of comparative studies did not show the superiority of a given treatment against another. A new international staging of the disease, however, allows physicians to discriminate several groups of patients for such comparative studies--in particular, for testing the efficacy of intrapleural therapy, e.g., cytokines--for early-stage MPM and multimodal management, i.e., extrapleural pneumonectomy, radiotherapy, and chemotherapy for more advanced diseases, has led to prolonged survival in carefully selected patients. To reach this target, all patients must be enrolled in protocols. The usual pessimism for the management of patients with malignant pleural mesothelioma is over.

• Pulmonary associations in familial Mediterranean fever. A. Livneh, P. Langevitz, M. Pras. 1999;5(5):326-31. Review PubMed · Publisher

  Abstract

  Familial Mediterranean fever (FMF) is a hereditary periodic fever syndrome expressed by acute episodes of fever and painful manifestations. In this report, the pulmonary manifestations of FMF are reviewed, the most prominent of which are chest attacks due to pleuritis. Nephropathic amyloidosis of the AA type, which complicates FMF in most untreated patients, may progress to affect other organs, including the lungs, but this rarely produces noticeable symptoms. The common association between FMF and vasculitis makes pulmonary hemorrhage, infarction, or infiltrates highly possible. These complications, however, have been reported only rarely. Asthma was found to occur less often than expected in patients with FMF, but methodologic faults make this finding doubtful. Finally, the occurrence of mesothelioma in five patients with FMF who were not exposed to asbestos suggests a role for recurrent FMF serositis in the pathogenesis of this malignancy.

• Occupational lung disease and the role of peptide growth factors. A.R. Brody. 1997;3(3):203-8. Review PubMed · Publisher

  Abstract

  Occupational lung disease can take many forms, including obstructive airway disease, asthma, and restrictive parenchymal fibrosis. It would not be useful to attempt an all-encompassing review of such a broad topic, even if one were restricted to the most recent literature. Thus, I have chosen a small corner of one disease process that relates to work ongoing in my laboratory, ie, the potential role of growth factors in the pathogenesis of fibroproliferative lung disease. This process is the cornerstone of interstitial pulmonary fibrosis, which is caused by inhaling such commonly used materials as asbestos and silica. Diffuse interstitial pulmonary fibrosis results from chronic exposures in the workplace, and the initial lesions of the fibroproliferative process that culminate in interstitial pulmonary fibrosis are readily produced in the laboratory by exposing rats and mice. The disease could be mediated by a combination of peptide growth factors and cytokines that are expressed at sites of lung injury.

• The pneumoconioses. W. Tsai, W.K. Morgan. 1996;2(2):116-20. Review PubMed · Publisher

  Abstract

  The stringent industrial hygiene regulations that have been introduced in North America, Europe, and Australasia have led to a decline in the incidence and prevalence of silicosis, coal workers' pneumoconiosis, and asbestosis. Although new cases of asbestosis are not occurring, an appreciable number of mesotheliomata are still being diagnosed, and there has yet been little, if any, decline in the latter tumor. These new cases are nearly entirely due to exposure to amphiboles in the 1940s and 1950s. It is expected that by about the year 2000 the incidence of mesothelioma will begin to decrease in the United States and Canada. Meanwhile there is an undue preoccupation with more and more sensitive methods of detecting asbestosis, silicosis, and coal workers' pneumoconiosis, eg, magnetic resonance imaging, bronchoalveolar lavage, and so forth. Much effort is being made in trying to detect disease in groups of workers with extremely low exposures and no symptoms. Smaller and smaller effects are being detected, with the ultimate aim appearing to be detecting nothing at all. Efforts should be made at surveying other populations exposed to agents that have recently been introduced and that could conceivably have long-term effects.

• Pleural malignancies including mesothelioma. G. Hillerdal. 1995;1(4):339-43. Review PubMed

  Abstract

  Malignant mesothelioma is caused almost exclusively by occupational exposure to asbestos. During the past few years, however, increasing evidence has mounted that background exposure to asbestos could be sufficient to cause mesothelioma. Treatment of malignant mesothelioma remains a big problem. Some new approaches are on their way, and the most exciting ones are local immunotherapy in very early cases. Some success has been reported with local interferon treatment. As for treatment of metastatic pleural disease, the main purpose is symptomatic relief of dyspnea caused by fluid accumulation. The best way to achieve a lasting palliation is pleurodesis, and the most common way to do this, is by chemical means. The drug of choice in the United States has for many years been tetracycline, but since injectable tetracycline is no longer available, some substitute must be found. The substance that will "win" is not yet clear, but the two leading contestants are talc and doxycycline. Bleomycin also has its supporters, and a dark horse is quinacrine, which although not easily available in the United States, has been used in many European centers for decades.

• Pleuritis and pleural effusions. M.W. Owens, S.A. Milligan. 1995;1(4):318-23. Review PubMed

  Abstract

  A variety of diseases either directly or indirectly affect the pleura, resulting in the accumulation of pleural fluid. A pleural effusion develops whenever the influx of fluid into the pleural space is greater than the efflux. It is now clear that the parietal pleura has the primary role in the reabsorption of pleural fluid normally and during pathologic conditions. Recently, models of experimental pleuritis have demonstrated the importance of inflammatory cytokines in the pathogenesis of both asbestos- and endotoxin-induced pleural effusions.

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