Internal Medicine Journal

Our medical research library holds 8 studies published in Internal Medicine Journal (2010–2022). 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. 7 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Blackwell Science Asia
• Published: 2001 to the present, Australia
• Language: English
• ISSN: 1444-0903 (print), 1445-5994 (electronic)
• Continues: Australian and New Zealand Journal of Medicine
• Its record in the NLM Catalog

2020s

• Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study. L. Pairman, L.E.L. Beckert, M. Dagger, et al. 2022;52(7):1154-1159. PubMed · Publisher · Free full text

  Abstract

  Background: Cytological examination of pleural fluid has good specificity, but imperfect sensitivity for the diagnosis of malignant pleural effusion (MPE). Published estimates of sensitivity vary and predictors of false negative cytology are not well established.

  Aims: To estimate pleural fluid cytology sensitivity and identify risk factors for false negative cytology.

  Methods: We conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand, from July 2017 to October 2019. Data on clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology or multidisciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results.

  Results: Initial pleural fluid cytology was diagnostic in 117 of 156 patients, providing a sensitivity (95% confidence interval (CI)) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (odds ratio (OR) 0.12; 95% CI 0.03-0.54) and yellow/gold pleural fluid (OR 0.24; 95% CI 0.06-0.96) reduced the odds of false negative pleural cytology. Pleural thickening on computed tomography scan (OR 3.3; 95% CI 1.2-9.4) was a risk factor for false negative cytology.

  Conclusion: Sensitivity of pleural fluid cytology was greatest in primary lung and breast cancer, and lowest in mesothelioma. Clinicians should be alert to false negative results when suspecting mesothelioma or if pleural thickening is present.

  © 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

• Osteopontin, GLUT1 and Ki-67 expression in malignant peritoneal mesothelioma: prognostic implications. Y. Liu, G. Zheng, D. Yang, et al. 2021;51(6):896-904. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant peritoneal mesothelioma is the most common primary peritoneal neoplasm. The only universally recognised pathological prognostic factor is histopathological subtype. Prognostic markers based on patient features and clinical stages have been disappointing.

  Aims: To assess the prognostic role of several clinicopathological features in a retrospective cohort of 60 patients diagnosed with peritoneal mesothelioma.

  Methods: Sixty patients were centrally collected and were immunohistochemically analysed for the expression of osteopontin (OPN), GLUT1 and Ki-67. Labelling was assessed by two pathologists. Complete clinical information and follow-up were obtained from patients' records.

  Results: OPN expression was identified in 52 (86.6%) of 60 specimens, and GLUT1 in 39 (65%) of 60 specimens. Univariate Cox regression analysis showed that a lower peritoneal carcinomatosis index (PCI), tumour-directed treatment (chemotherapy or surgery alone or in any combination), lower Ki-67, GLUT1 and lower OPN expression had a statistically significant positive effect on overall survival (OS). PCI (hazard ratio (HR) = 1.032 (95% confidence interval (CI): 1.000-1.067); P = 0.054) and tumour-directed treatment (HR = 0.211 (95% CI: 0.104-0.430); P < 0.001), Ki-67 (HR = 22.326 (95% CI: 3.523-141.498); P = 0.003) and OPN (HR = 7.268 (95% CI: 1.771-29.811); P = 0.009) retained independent prognostic significance in the multivariate analysis, all with a positive effect on OS with the exception of GLUT1.

  Conclusions: OPN, Ki-67, treatment and PCI were independent indicators for OS, and a higher level of OPN expression correlated significantly with poorer OS.

  © 2020 Royal Australasian College of Physicians.

• Malignant mesothelioma presenting as a solitary perifissural nodule. L. Mo, B. Adler, C. Green, et al. 2020;50(12):1592-1594. Letter PubMed · Publisher

2010s

• The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia. L. Mileshkin, C. Dunn, H. Cross, et al. 2019;49(8):1001-1006. PubMed · Publisher

  Abstract

  Background: Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers.

  Aim: To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service.

  Methods: We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data.

  Results: Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services.

  Conclusion: Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.

  © 2018 Royal Australasian College of Physicians.

• Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience. P. Loveland, M. Christie, G. Hammerschlag, et al. 2018;48(11):1318-1324. PubMed · Publisher

  Abstract

  Background: Timely diagnosis of malignant pleural effusions is critical to guide prognosis and management decisions. Cytological analysis of pleural fluid has been the first-line diagnostic test for many decades, with highly variable reported sensitivities of 40-90%. Its diagnostic accuracy in modern practice in Australia needs to be understood.

  Aims: To determine the diagnostic yield of pleural fluid cytology for the detection of malignant pleural effusions and to determine the aetiologies of pleural effusions at our centre.

  Methods: The study involved the retrospective chart review of all pleural fluid samples submitted for cytological analysis at a tertiary referral centre in Melbourne, Australia, over a 12-month period. Aetiology of all effusions was determined, and sensitivity, specificity, negative predictive value and diagnostic accuracy for the detection of malignant pleural effusions were calculated. We also examined diagnostic yield based on tumour cell type.

  Results: Of the 153 cases analysed, 61 (39.9%) were malignant. Lung cancers accounted for 44.3% of malignant effusions, followed by mesothelioma (18%), ovarian carcinoma (11.5%) and lymphoma (8.2%). The commonest single causes of a benign effusion were cardiac (16.3%) and parapneumonic (13%). Sensitivity for diagnosis of malignant effusions was 67.2% overall, but 87.9% for adenocarcinomas and only 45.5% for mesothelioma.

  Conclusion: Tumour type is an important determinant of pleural fluid cytology diagnostic yield. Cytology has good sensitivity and specificity for the diagnosis of adenocarcinoma, but if another tumour type is suspected, particularly mesothelioma, clinicians should be aware of the limitations.

  © 2018 Royal Australasian College of Physicians.

• Patterns of care for malignant pleural mesothelioma patients compensated by the Dust Diseases Board in New South Wales, Australia. S.C. Kao, S. Clarke, J. Vardy, et al. 2013;43(4):402-10. PubMed · Publisher

  Abstract

  Background: The silent epidemic of mesothelioma in Australia is steadily increasing, and 30% of cases occur in New South Wales (NSW).

  Aim: To describe the patterns of care and outcomes of patients with malignant pleural mesothelioma (MPM) in NSW.

  Methods: MPM patients in NSW applying for compensation at the NSW Dust Diseases Board from 2007 to 2009 were included. Survival from time of diagnosis was determined by the Kaplan-Meier method. The Chi-squared test was used to determine if there was an association between utilisation of treatment and geographical location.

  Results: A total of 138 patients was included: median age was 72.5; 91.3% male; 60.1% epithelial subtype; and 65.2% lived in major cities. All patients had at least one chest X-ray and computed tomography scan, and 21% had a positron emission tomography scan; 93.5% and 4.3% had histological or cytological confirmation respectively. Thoracoscopy (59.4%) was the most commonly used diagnostic procedure. Treatment utilisation: 53.6% chemotherapy; 35.5% radiotherapy; 9.4% extrapleural pneumonectomy (EPP); and 72.5% had palliative care involvement. There were no major differences in treatment utilisation between patients living in major cities and those in regional NSW (chemotherapy P = 0.42; radiotherapy P = 0.13 and palliative care P = 0.60), except for a higher rate of EPP in regional patients (16.7% vs 5.6%; P = 0.03). Median survival was 9.7 versus 12.3 months for city and regional patients respectively (P = 0.22).

  Conclusion: Survival and treatment utilisation was not significantly different between MPM patients living in major cities and regional NSW, except for a higher rate of EPP in patients in regional NSW.

  © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

• Asbestos-related disease. E. Jamrozik, N. de Klerk, A.W. Musk. 2011;41(5):372-80. Review PubMed · Publisher

  Abstract

  Inhalation of airborne asbestos fibres causes several diseases. These include asbestosis, lung cancer, malignant mesothelioma as well as pleural effusion, discrete (plaques) or diffuse benign pleural fibrosis and rolled atelectasis. The lag time between exposure and the development of disease may be many decades, thus the health risks of asbestos continue to be relevant despite bans on the use of asbestos and improvements in safety regulations for those who are still exposed. Asbestos was mined and used extensively in Australia for over 100 years and Australia is now experiencing part of a worldwide epidemic of asbestos-related disease. This review provides insight into the history and epidemiology of asbestos-related disease in Australia and discusses relevant clinical aspects in their diagnosis and management. The past and current medico-legal aspects of asbestos as well as currently evolving areas of research and future projections are summarized.

  © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

• Malignant mesothelioma. S.C. Kao, G. Reid, K. Lee, et al. 2010;40(11):742-50. Review PubMed · Publisher

  Abstract

  Malignant mesothelioma (MM) is an aggressive tumour that commonly affects the mesothelial surfaces of the pleural and peritoneal cavities, and occasionally, the tunica vaginalis and the pericardium. Formerly a rare tumour, MM is increasing in incidence in Australia due to the heavy nationwide use of asbestos from 1940 until the 1980s. The incidence is expected to peak in Australia in the next decade, mirroring the long latency period between asbestos exposure and development of MM. Diagnosis of MM can be difficult. Definitive pathological diagnosis is required and it often requires an experienced pathologist to differentiate MM from other benign or malignant processes. Treatment of MM requires a multidisciplinary approach, regardless of palliative or curative intent. Treatment options, such as surgery, chemotherapy, radiotherapy and active symptom control or a combination of these, may be used. Further research is needed to advance the therapeutic options for MM, and strategies to realize personalisation of therapy through discovery of predictive markers. In the Australian society where asbestos contamination of the built environment is very high, education and stringent public health measures are required to prevent a second wave of increased MM incidence.

  © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

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