Nonspecific pleuritis: optimal duration of follow-up

Our plain-English summary of Nonspecific pleuritis: optimal duration of follow-up, by Z.S. DePew, A. Verma, D. Wigle, et al (The Annals of Thoracic Surgery, 2014).

The study

• Authors: Z.S. DePew, A. Verma, D. Wigle, J.J. Mullon, F.C. Nichols, F. Maldonado
• Journal: The Annals of Thoracic Surgery
• Published: 2014;97(6):1867-71
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Nonspecific pleuritis (NSP) is a frequent diagnosis after parietal pleural biopsy, but the clinical significance of this finding and need for further follow-up have not been firmly established. Previous reports suggest that 5% to 25% of patients with NSP are subsequently diagnosed with pleural malignancy.

Methods: Our pathology database was queried for patients with histologic evidence of NSP from January 01, 2001, to December 31, 2012 (n = 413). Patients with less than 1 year of follow-up after biopsy, diagnosis of empyema, tuberculous pleuritis, active systemic connective tissue disease or vasculitis, or active malignancy were excluded (n = 327). The remaining patients were included and their medical records were reviewed.

Results: Eighty-six patients were included. Mean follow up was 1,824 ± 1,032 days (range, 409 to 4,599 days). Three of the 86 patients with NSP (3.5%) were subsequently diagnosed with pleural malignancy. All 3 patients were found to have mesothelioma with a mean time from biopsies to diagnosis of 205 ± 126 days (range, 64 to 306 days). Twenty-two of 86 patients (25.5%) had a possible identifiable cause of pleural inflammation (benign disease). After exclusion of these 22 patients, the incidence of malignancy was 3 of 64 (4.7%).

Conclusions: The incidence of subsequent pleural malignancy (mesothelioma) among patients found to have NSP based on pleural biopsy was 3.5%. Occult mesothelioma in patients with NSP will most likely be diagnosed within 1 year of the initial pleural biopsy; therefore, these patients should be followed for a minimum of 1 year to allow for timely detection of occult pleural malignancy.

Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This retrospective review from Mayo Clinic in Rochester, Minnesota, followed patients whose biopsy of the parietal pleura (the chest lining) showed only nonspecific pleuritis, a finding of acute or chronic inflammation, with or without scarring (fibrosis). The pathology database held 413 such cases from 2001 to 2012. The authors excluded 327 patients who had less than 1 year of follow-up or a known cause such as empyema, tuberculous pleuritis or active cancer, leaving 86, who were followed for a mean of 1,824 days. Three of the 86 (3.5%) were later diagnosed with mesothelioma (two sarcomatoid, one biphasic), between 64 and 306 days after the biopsy. Among the 64 patients with no possible identifiable cause of inflammation, the figure was 3 of 64 (4.7%). Two of the three had known asbestos exposure at work; the third had no prior history of asbestos exposure. The authors concluded that hidden mesothelioma will most likely be found within 1 year of the biopsy, though longer is possible, and that these patients warrant follow-up for at least 1 year. They noted the study was retrospective, from one center, and relied on medical records.

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: Retrospective review of medical records from a single center (Mayo Clinic), with descriptions of the three patients later diagnosed with mesothelioma
• Who was studied: Mayo Clinic pathology database: 413 cases of parietal pleural biopsy diagnosed as nonspecific pleuritis, from January 1, 2001 to December 31, 2012. After 327 were excluded, 86 patients were studied. Their mean age was 66.3 years and 59.3% were male. Of the 86, 22 had a possible identifiable benign cause of their inflammation, leaving 64 with idiopathic nonspecific pleuritis.
• Exposure: The study did not examine asbestos fiber types or doses. It followed patients after a biopsy diagnosis of nonspecific pleuritis. Asbestos exposure was described only for the three patients later diagnosed with mesothelioma. Patient 1 was a pipefitter for many years. Patient 2 was a construction worker who also dismantled old boilers and boats. Patient 3 had no prior history of asbestos exposure.
• Main results:
  • Among all 86 included patients, 3 (3.5%) were subsequently diagnosed with pleural malignancy, and all 3 had mesothelioma.
  • Among the 64 patients with idiopathic nonspecific pleuritis (after excluding the 22 with a possible benign cause), the incidence of malignancy was 3 of 64 (4.7%).
  • For the three mesothelioma patients, the time from the biopsy showing nonspecific pleuritis to the cancer diagnosis was 244, 306 and 64 days. The longest was about 10 months, against a mean follow-up of 1,824 plus or minus 1,032 days (range 409 to 4,599) for all 86 patients.
  • The three patients later diagnosed with mesothelioma were men aged 74, 73 and 71. Two had sarcomatoid mesothelioma and one had biphasic mesothelioma. In all three, the biopsy showing nonspecific pleuritis had been taken by video-assisted thoracoscopic surgery (VATS).
  • The authors reported that all three mesothelioma patients complained of significant chest pain before or after their initial pleural biopsies.
• The authors' conclusion: The authors concluded that nonspecific pleuritis most usually follows a benign course but should not be considered a benign diagnosis. In their view, occult mesothelioma will most likely be diagnosed within 1 year of the initial biopsy, though longer durations are possible. They recommended clinical follow-up for at least 1 year, preferably with chest imaging at 3, 6 and 12 months, and wrote elsewhere that 2 years may be preferable.
• Limitations the authors state:
  • The data were collected retrospectively from a single center.
  • Because the study was retrospective, the authors relied on clinical documentation in the electronic medical record, with the limitations that brings.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Biopsy, Pathology, Biopsy, Empyema, Mesothelioma, Inflammation.

Related studies

• Chronic follicular pleuritis: a B cell-rich form of nonspecific pleuritis/fibrosis — S.A. Yousem (2019)
• Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies — H.E. Davies, J.E. Nicholson, et al. (2010)
• Outcome of patients with nonspecific pleuritis at thoracoscopy — J.M. Wrightson, H.E. Davies (2011)
• Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy — M. Metintas, G. Ak, et al. (2012)
• What is the significance of non-specific pleuritis? A trick question — J. Janssen, F. Maldonado, et al. (2018)
• Diagnostic usefulness of p16/CDKN2A FISH in distinguishing between sarcomatoid mesothelioma and fibrous pleuritis — D. Wu, K. Hiroshima, et al. (2013)

Browse more research in The Annals of Thoracic Surgery, or return to medical research.