European Respiratory Review

Our medical research library holds 15 studies published in European Respiratory Review (2010–2026). 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. 15 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: European Respiratory Society
• Published: 1991 to the present, England
• Language: English
• ISSN: 0905-9180 (print), 1600-0617 (electronic)
• Its record in the NLM Catalog

2020s

• Carcinoids of the lung caused by exogenous noxious agents: a scoping review. S. Kilo, C. Schröder, L. Frei-Stuber, et al. 2026;35(182). PubMed · Publisher · Free full text

  Abstract

  Background: Approximately 2% of lung tumours are pulmonary carcinoids (PCs), divided into typical (90%) and atypical (AC) (10%). The link with external exposure to carcinogens remains controversial.

  Objective: To investigate the association between occupational exposure to carcinogens and PC tumours.

  Methods: A PRISMA-ScR-guided scoping review was performed. A systematic search was conducted in PubMed and Embase (January 2025). Studies were reviewed, data extracted, analysed and summarised narratively.

  Results: 1302 studies were reviewed. 27 original studies and seven conference papers on topics including exposure to cigarette smoke (n=23) and asbestos (n=6), or mechanistic information, were included. Following the collapse of the World Trade Center in 2001, carcinoids accounted for 6% of lung cancer cases in people exposed to the resulting dust (9% in women, 3% in men). The proportion of ACs among carcinoids rose from 9.3% (controls) to 16.3% (smokers) and from ∼25% to 45% (probable versus definite asbestos exposure). Basic research has identified biological pathways linking harmful exposures (such as asbestos and cigarette smoke) to neuroendocrine cell proliferation and the potential progression of PCs to higher-grade lung tumours.

  Discussion: The significance these of findings is limited due to 1) the limited number of studies, 2) the small number of tumours within those studies and 3) the lack of rigid diagnostic (morphological and molecular) criteria for PCs in most studies. Nevertheless, a consistent finding is a higher proportion of AC among carcinoids, particularly following asbestos exposure.

  Conclusions: Based on these findings, a link between carcinogenic substances (especially asbestos and cigarette smoke) and carcinoids seems plausible. More stringent analyses in epidemiological surveys are needed to further clarify the pathogenesis of PCs.

  Copyright ©The authors 2026.

• Diagnostic performance and safety of image-guided pleural biopsy and medical thoracoscopy for undiagnosed exudative pleural effusion: a systematic review and network meta-analysis. S. Lyu, Z. Zheng, L. Liao, et al. 2026;35(180). Systematic review PubMed · Publisher · Free full text

  Abstract

  Introduction: Undiagnosed exudative pleural effusions often require pleural biopsy for a definitive diagnosis. The optimal sampling method, particularly when medical thoracoscopy is compared with image-guided pleural biopsy, remains uncertain.

  Methods: This systematic review and network meta-analysis included studies that reported on the diagnostic performance and safety of medical thoracoscopy and image-guided pleural biopsy approaches. The primary outcome of this study was diagnostic yield, and the secondary outcomes included other diagnostic parameters (e.g. sensitivity, negative likelihood ratio, and negative predictive value), post-procedure complications, and biopsy quality and number. A frequentist network meta-analysis was performed to compare and rank the diagnostic performance and safety of various pleural biopsy methods using a random-effects model. A subgroup analysis was performed according to the presence of pleural nodules or thickness and the type of biopsy needles used.

  Results: An analysis of 64 studies involving 8744 patients revealed that rigid medical thoracoscopy had the highest diagnostic yield (95.0%), followed by cryobiopsy (93.1%), semirigid medical thoracoscopy (92.3%), and ultrasound elastography (UE)-guided biopsy (92.3%). Closed pleural biopsy had the lowest yield (75.1%). The current evidence is insufficient to establish the superiority of any biopsy method in terms of complications. The network meta-analysis ranked rigid medical thoracoscopy as having the highest overall diagnostic yield, closely followed by UE-guided biopsy, with no statistically significant differences between image-guided biopsy and rigid medical thoracoscopy.

  Conclusion: Closed pleural biopsy consistently has a low diagnostic yield and is not recommended as a first-line biopsy method for patients with undiagnosed exudative pleural effusions. Rigid medical thoracoscopy offers distinct clinical value for a complete visual inspection, large biopsies, and potential pleurodesis, particularly in suspected mesothelioma cases. The currently available evidence does not support the routine replacement of semirigid medical thoracoscopy with cryobiopsy. Computed tomography-guided biopsy may be preferred in cases involving thickening ≥10 mm or small target lesions. Conversely, ultrasound-guided biopsy may be appropriate for lesions measuring ≥3 mm with a clear acoustic window. UE-guided pleural biopsy shows promise as an emerging option, although the evidence is limited. In tuberculous pleurisy, medical thoracoscopy may offer higher diagnostic sensitivity in certain settings, particularly in high-prevalence areas. The current evidence is insufficient to establish a clear advantage for any biopsy method regarding the overall complication risk.

  Copyright ©The authors 2026.

• Present and future of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for pleural metastases: a narrative review. A. Hajja, M. Atout, R. Turko, et al. 2026;35(179). Review PubMed · Publisher · Free full text

  Abstract

  Background: Pleural malignancies pose a significant clinical challenge due to their poor prognosis and limited treatment options. Hyperthermic intrathoracic chemotherapy (HITHOC) is an emerging modality that has shown promise in treating primary pleural cancers when used with cytoreductive surgery (CRS), but its efficacy in treating pleural malignancies other than mesothelioma remains underexplored. This review aims to evaluate recent advancements in HITHOC use for nonmesothelioma pleural cancers and provide insights into its potential clinical applications.

  Methods: A comprehensive Boolean search was conducted using PubMed/Medline and Google Scholar to identify relevant studies on the use of HITHOC for nonmesothelioma pleural cancers. Studies exclusively focused on pleural mesothelioma were excluded. Findings were summarised to address key questions regarding HITHOC's effectiveness, integration with other therapies and obstacles to its broader use.

  Results: HITHOC, when combined with CRS, could prolong overall and progression-free survival and reduce complication and mortality rates in patients with advanced pleural cancers. Advances in chemo-immunotherapy, the evolution of minimally invasive techniques and the emergence of precision surgery hold significant promise in the treatment of pleural malignancies.

  Conclusion: Given the challenges associated with HITHOC, including protocol variability and technical complexity, future research using larger, multinational datasets is essential to support its broader application and to identify patient-specific characteristics that enhance its efficacy in treating pleural cancers.

  Copyright ©The authors 2026.

• Lung cancer risk and occupational pulmonary fibrosis: systematic review and meta-analysis. J. Krabbe, K.M. Steffens, S. Drießen, et al. 2024;33(171). Meta-analysis · Systematic review PubMed · Publisher · Free full text

  Abstract

  Background: Molecular pathways found to be important in pulmonary fibrosis are also involved in cancer pathogenesis, suggesting common pathways in the development of pulmonary fibrosis and lung cancer.

  Research Question: Is pulmonary fibrosis from exposure to occupational carcinogens an independent risk factor for lung cancer?

  Study Design And Methods: A comprehensive search of PubMed, Embase, Web of Science and Cochrane databases with over 100 search terms regarding occupational hazards causing pulmonary fibrosis was conducted. After screening and extraction, quality of evidence and eligibility criteria for meta-analysis were assessed. Meta-analysis was performed using a random-effects model.

  Results: 52 studies were identified for systematic review. Meta-analysis of subgroups identified silicosis as a risk factor for lung cancer when investigating odds ratios for silicosis in autopsy studies (OR 1.47, 95% CI 1.13-1.90) and for lung cancer mortality in patients with silicosis (OR 3.21, 95% CI 2.67-3.87). Only considering studies with an adjustment for smoking as a confounder identified a significant increase in lung cancer risk (OR 1.58, 95% CI 1.34-1.87). However, due to a lack of studies including cumulative exposure, no adjustments could be included. In a qualitative review, no definitive conclusion could be reached for asbestosis and silicosis as independent risk factors for lung cancer, partly because the studies did not take cumulative exposure into account.

  Interpretation: This systematic review confirms the current knowledge regarding asbestosis and silicosis, indicating a higher risk of lung cancer in exposed individuals compared to exposed workers without fibrosis. These individuals should be monitored for lung cancer, especially when asbestosis or silicosis is present.

  Copyright ©The authors 2024.

• Rare thoracic cancers: a comprehensive overview of diagnosis and management of small cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours. D.W. Dumoulin, P. Bironzo, F. Passiglia, et al. 2023;32(167). Review PubMed · Publisher · Free full text

  Abstract

  Despite the progress in outcomes seen with immunotherapy in various malignancies, including nonsmall cell lung cancer, the benefits are less in small cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours. New effective treatment options are needed, guided via more in-depth insights into the pathophysiology of these rare malignancies. This review comprehensively presents an overview of the clinical presentation, diagnostic tools, staging systems, pathophysiology and treatment options for these rare thoracic cancers. In addition, opportunities for further improvement of therapies are discussed.

  Copyright ©The authors 2023.

• Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis. G. Martinez-Zayas, S. Molina, D.E. Ost. 2022;31(166). Systematic review · Meta-analysis PubMed · Publisher · Free full text

  Abstract

  Background: Thoracentesis and thoracoscopy are used to diagnose malignant pleural effusions (MPE). Data on how sensitivity varies with tumour type is limited.

  Methods: Systematic review using PubMed was performed through August 2020 to determine the sensitivity of thoracentesis and thoracoscopy for MPE secondary to malignancy, by cancer type, and complication rates. Tests to identify sources of heterogeneity were performed. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and National Institutes of Health quality assessment tools. Publication bias was tested using funnel plots.

  Results: Meta-analyses for sensitivity of thoracentesis for MPE secondary to malignancy, mesothelioma and lung and breast cancer included 29, eight, 12 and nine studies, respectively. Pooled sensitivities were 0.643 (95% CI 0.592-0.692), 0.451 (95% CI 0.249-0.661), 0.738 (95% CI 0.659-0.836) and 0.820 (95% CI 0.700-0.917), respectively. For sensitivity of thoracoscopy for MPE secondary to malignancy and mesothelioma, 41 and 15 studies were included, respectively. Pooled sensitivities were 0.929 (95% CI 0.905-0.95) and 0.915 (95% CI 0.871-0.952), respectively. Pooled complication rates of thoracentesis and thoracoscopy were 0.041 (95% CI 0.025-0.051) and 0.040 (95% CI 0.029-0.052), respectively. Heterogeneity was significant for all meta-analyses. Funnel plots were asymmetric.

  Interpretation: Sensitivity of thoracentesis varied significantly per cancer type. Pooled complication rates were low. Awareness of how sensitivity of thoracentesis changes across cancers can improve decision-making when MPE is suspected.

  Copyright ©The authors 2022.

• Clinical utility of diagnostic biomarkers in malignant pleural mesothelioma: a systematic review and meta-analysis. E. Schillebeeckx, J.P. van Meerbeeck, K. Lamote. 2021;30(162). Meta-analysis · Systematic review PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is characterised by late-stage diagnosis and poor prognosis. Currently, no screening tool is advocated and diagnosis is based on invasive techniques, which are not well tolerated. Non-invasive diagnostic biomarkers have shown potential and could have a huge clinical benefit. However, despite extensive research, there is no consensus yet on their clinical use, with many articles reporting contradicting results, limiting their clinical implementation. The aim of this systematic review is therefore to explore the different semi- and non-invasive diagnostic markers in several human matrices and identify those that might clinically be relevant. A total of 100 articles were selected through Web of Science and PubMed, with 56 articles included in the quantitative analysis. Although many studies have reported on the diagnostic accuracy of MPM biomarkers such as serum mesothelin and high-mobility group box protein 1 and plasma fibulin-3, none have resulted in a validated test for early detection. Future research should focus on external validation, combinations into biomarker panels, the inclusion of early stage MPM patients and a combination of different biomarker matrices, as well as new markers.

  Copyright ©The authors 2021.

• Epigenetics and sarcoidosis. I.R. Konigsberg, L.A. Maier, I.V. Yang. 2021;30(160). Review PubMed · Publisher · Free full text

  Abstract

  Epigenetic modifications are emerging as important regulatory mechanisms of gene expression in lung disease, given that they are influenced by environmental exposures and genetic variants, and that they regulate immune and fibrotic processes. In this review, we introduce these concepts with a focus on the study of DNA methylation and histone modifications and discuss how they have been applied to lung disease, and how they can be applied to sarcoidosis. This information has implications for other exposure and immunologically mediated lung diseases, such as chronic beryllium disease, hypersensitivity pneumonitis, and asbestosis.

  Copyright ©The authors 2021.

• The efficacy of immune checkpoint inhibitors in thoracic malignancies. J. Remon, F. Facchinetti, B. Besse. 2021;30(162). Review PubMed · Publisher · Free full text

  Abstract

  The advent of immune checkpoint inhibitors (ICIs) has rapidly transformed the treatment paradigm for multiple cancer types, including thoracic malignancies. In advanced non-small cell lung cancer (NSCLC), ICIs have shifted treatment paradigm and improved overall survival reaching almost one-third of patients alive at 5 years. ICIs therapies have also modified the therapeutic strategy in first-line setting in metastatic small-cell lung cancer (SCLC) patients as well as in malignant pleural mesothelioma (MPM) improving the overall survival compared with standard treatment. This phenomenon is of huge relevance as both SCLC and MPM were considered orphan diseases without any significant improvement in the therapeutic strategy in the first-line setting during the last 15 years. In this review, we aim to review the efficacy of ICI in thoracic malignancies either in monotherapy or in combination, according to predictive biomarkers, and to the US Food and Drug Administration and the European Medicines Agency approvals of treatment strategies. We address the efficacy of these agents, especially in NSCLC according to PD-L1 expression and histologic subtype.

  Copyright ©The authors 2021.

• Update on biology and management of mesothelioma. R. Asciak, V. George, N.M. Rahman. 2021;30(159). Review PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma is an aggressive, incurable cancer that is usually caused by asbestos exposure several decades before symptoms arise. Despite widespread prohibition of asbestos production and supply, its incidence continues to increase. It is heterogeneous in its presentation and behaviour, and diagnosis can be notoriously difficult. Identification of actionable gene mutations has proven challenging and current treatment options are largely ineffective, with a median survival of 10-12 months.However, the past few years have witnessed major advances in our understanding of the biology and pathogenesis of mesothelioma. This has also revealed the limitations of existing diagnostic algorithms and identified new treatment targets.Recent clinical trials have re-examined the role of surgery, provided new options for the management of associated pleural effusions and heralded the addition of targeted therapies. The increasing complexity of mesothelioma management, along with a desperate need for further research, means that a multidisciplinary team framework is essential for the delivery of contemporary mesothelioma care.This review provides a synthesised overview of the current state of knowledge and an update on the latest research in the field.

  Copyright ©ERS 2021.

2010s

• Drug repurposing in malignant pleural mesothelioma: a breath of fresh air?. A. Boyer, E. Pasquier, P. Tomasini, et al. 2018;27(147). Review PubMed · Publisher · Free full text

  Abstract

  Drug repurposing is the use of known drugs for new indications. Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. So far, few treatments have been approved in this disease. However, its incidence is expected to increase significantly, particularly in developing countries. Consequently, drug repurposing appears as an attractive strategy for drug development in MPM, since the known pharmacology and safety profile based on previous approvals of repurposed drugs allows for faster time-to-market for patients and lower treatment cost. This is critical in low- and middle-income countries where access to expensive drugs is limited. This review assesses the published preclinical and clinical data about drug repurposing in MPM.In this review, we identified 11 therapeutic classes that could be repositioned in mesothelioma. Most of these treatments have been evaluated in vitro, half have been evaluated in vivo in animal models of MPM and only three (i.e. valproate, thalidomide and zoledronic acid) have been investigated in clinical trials, with limited benefits so far. Efforts could be coordinated to pursue further investigations and test promising drugs identified in preclinical experiments in appropriately designed clinical trials.

  Copyright ©ERS 2018.

• Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. A.C. Bibby, S. Tsim, N. Kanellakis, et al. 2016;25(142):472-486. Review PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

  Copyright ©ERS 2016.

• Malignant pleural mesothelioma: history, controversy and future of a manmade epidemic. O.D. Røe, G.M. Stella. 2015;24(135):115-31. Historical article · Review PubMed · Publisher · Free full text

  Abstract

  Asbestos is the term for a family of naturally occurring minerals that have been used on a small scale since ancient times. Industrialisation demanded increased mining and refining in the 20th century, and in 1960, Wagner, Sleggs and Marchand from South Africa linked asbestos to mesothelioma, paving the way to the current knowledge of the aetiology, epidemiology and biology of malignant pleural mesothelioma. Pleural mesothelioma is one of the most lethal cancers, with increasing incidence worldwide. This review will give some snapshots of the history of pleural mesothelioma discovery, and the body of epidemiological and biological research, including some of the controversies and unresolved questions. Translational research is currently unravelling novel circulating biomarkers for earlier diagnosis and novel treatment targets. Current breakthrough discoveries of clinically promising noninvasive biomarkers, such as the 13-protein signature, microRNAs and the BAP1 mesothelioma/cancer syndrome, are highlighted. The asbestos history is a lesson to not be repeated, but here we also review recent in vivo and in vitro studies showing that manmade carbon nanofibres could pose a similar danger to human health. This should be taken seriously by regulatory bodies to ensure thorough testing of novel materials before release in the society.

  Copyright ©ERS 2015.

• Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?. W.A. Wuyts, A. Cavazza, G. Rossi, et al. 2014;23(133):308-19. PubMed · Publisher · Free full text

  Abstract

  Idiopathic pulmonary fibrosis (IPF), the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological and/or pathological pattern of usual interstitial pneumonia (UIP). However, UIP is not synonymous with IPF as other clinical conditions may be associated with UIP, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug toxicity, asbestosis, familial IPF and Hermansky-Pudlak syndrome. Differentiating IPF ("idiopathic UIP") from conditions that mimic IPF ("secondary UIP") has substantial therapeutic and prognostic implications. A number of radiological and histological clues may help distinguish IPF from other conditions with a UIP pattern of fibrosis, but their appreciation requires extensive expertise in interstitial lung disease as well as an integrated multidisciplinary approach involving pulmonologists, radiologists and pathologists. In addition, multidisciplinary discussions may decrease the time to initial IPF diagnosis and, thus, enable more timely management. This concept was strongly emphasised by the 2011 ATS/ERS/JRS/ALAT guidelines. This article highlights, with the aid of a clinical case, the difficulties in making a diagnosis of IPF in clinical practice. Yet, an accurate diagnosis is critical, particularly given the availability of drugs that may reduce the pace of functional decline and disease progression in IPF.

  ©ERS 2014.

• Retrosternal and pleural "bridging" fibrosis mimicking malignancy in a patient exposed to asbestos. M.P. Debray, S. Marchand-Adam, R. Soufan, et al. 2010;19(116):158-60. Case report PubMed · Publisher · Free full text

  Abstract

  Mediastinal fibrosis is a rare, benign disorder characterised by proliferation of fibrous tissue within the mediastinum. It can present as diffuse mediastinal infiltration or, more frequently, as a localised soft tissue mass, usually in the right paratracheal or subcarinal areas. 18-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) imaging has only been reported in a few case reports with variable aspects. Herein, we present an unusual pattern of mediastinal fibrosis, presenting as a thick retrosternal mass contiguous with pleural thickening. 18-FDG PET showed intensely increased uptake in the mass. Both the location of fibrosis and PET imaging were confusing with malignancy. Histopathological proof of benign fibrosis was obtained by surgery. The patient had been exposed to asbestos and the possible relationship of this particular pattern of fibrosis with asbestos exposure will be discussed.

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