Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG)

Our plain-English summary of Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG), by C. Geltner, P. Errhalt, B. Baumgartner, et al (Wiener Klinische Wochenschrift, 2016).

The study

• Authors: C. Geltner, P. Errhalt, B. Baumgartner, G. Ambrosch, B. Machan, J. Eckmayr, T. Klikovits, M.A. Hoda, H. Popper, W. Klepetko, Austrian Mesothelioma Interest Group (AMIG)
• Journal: Wiener Klinische Wochenschrift
• Published: 2016;128(17-18):611-7
• Type of article: Consensus statement
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare malignant disease that in the majority of cases is associated with asbestos exposure. The incidence in Europe is about 20 per million inhabitants and it is increasing worldwide. Initial symptoms are shortness of breath, pleural effusion, cough, and chest pain. The typical growth pattern is along the pleural surface; however, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage. Ultimately, distant metastases outside the chest can result. Several histological subtypes of pleural mesothelioma exist, which must be differentiated from either benign diseases or metastases in the pleural space by other tumor entities. This differential diagnosis can be very difficult and a large panel of immunohistochemical markers is required to establish the exact diagnosis. The standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis is videothoracoscopy. Full thickness biopsies are required, while transthoracic needle puncture of pleural fluid or tissue is considered to be insufficient for a cytological diagnosis. Complete and detailed staging is mandatory for categorization of the disease as well as for therapeutic decision making.

In plain English

This article is a consensus report by the Austrian Mesothelioma Interest Group (AMIG), not an original study. It reviewed published literature and guidelines on the epidemiology, diagnosis and staging of malignant pleural mesothelioma (MPM). Citing other work, the authors described asbestos exposure as the main risk factor. They reported that the Austrian insurer AUVA had approved 276 MPM cases as occupationally caused within the last 5 years, 53 of them in 2014. By comparison, ten asbestos-related MPM cases were documented in 1995 and 41 in 2005. The authors noted uncertainty about cases not reported to AUVA. They stated that current European guidelines recommend no general screening, and that blood biomarkers give too many false-positive results to be reliable screening tools. They described CT as reaching a sensitivity of only 40%, and thoracoscopy as the standard procedure for obtaining tissue, with full-thickness biopsies required. The authors concluded that complete and detailed staging is mandatory for categorizing the disease and for treatment decisions. They proposed a staging algorithm for patients in Austria.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Consensus report (narrative review of published literature and guidelines) by an expert group
• Who was studied: No study population; the report addresses the epidemiology, diagnosis and staging of malignant pleural mesothelioma and proposes an approach for MPM patients in Austria
• Exposure: Asbestos in general, discussed as background from cited literature. The fiber types listed are chrysotile, crocidolite, amosite, anthophyllite, tremolite and actinolite. Citing another study, the authors state that amosite and crocidolite seem to have a higher carcinogenicity than other types.
• Main results:
  • In Austria, 276 MPM cases were approved by AUVA (the General accident insurance company) as occupationally caused within the last 5 years, 53 of them in 2014 alone. Ten asbestos-related MPM cases were documented in 1995 and 41 in 2005. The authors note uncertainty about the number of cases not reported to AUVA.
  • The authors state that current ESTS/ERS guidelines recommend no general screening methods. Circulating biomarkers (osteopontin, mesothelin-related peptides, SMRP, fibulin-3) are not considered reliable screening tools because false-positive results are too frequent.
  • The authors state that CT does not allow a definitive diagnosis, since its sensitivity reaches only 40%, and in most cases it does not distinguish benign from malignant processes.
  • Precise diagnosis requires histopathological confirmation, and thoracoscopy remains the standard procedure for obtaining tissue. CT- or ultrasound-guided fine needle biopsy should be performed only in exceptional situations, as it has a clearly lower sensitivity.
  • Full-thickness biopsies are required to separate invasive from noninvasive growth, and a panel of immunohistochemical markers is needed to tell epithelioid MPM from adenocarcinoma.
  • Three histological types are described: epithelioid (50 to 70%), sarcomatoid (7 to 20%), and mixed or biphasic (20 to 35%).
  • Proposed staging: after initial CT and confirmation of disease by VATS, a potential surgical candidate should undergo PET-CT. Mediastinal lymph node involvement should be confirmed histologically, by EBUS/EUS-TBNA, mediastinoscopy or VATS. Staging uses the IMIG TNM system approved by the UICC.
• The authors' conclusion: The authors concluded that complete and detailed staging is mandatory for categorizing the disease and for therapeutic decision making.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epidemiology, Staging, Mesothelioma, Asbestos Exposure, Pleural Effusion, Histological Subtype, Differential Diagnosis.

Related studies

• Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG) — M.A. Hoda, T. Klikovits, et al. (2016)
• Management of malignant pleural mesothelioma - part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database — T. Klikovits, M.A. Hoda, et al. (2016)
• Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group — D. Rice, V. Rusch, et al. (2011)
• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)
• A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group — V.W. Rusch (1996)

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