Pleural mesothelioma: When echo-endoscopy (EUS-B-FNA) leads to diagnosis in a minimally invasive way

Our plain-English summary of Pleural mesothelioma: When echo-endoscopy (EUS-B-FNA) leads to diagnosis in a minimally invasive way, by R. Piro, M. Fontana, F. Livrieri, et al (Thoracic Cancer, 2021).

The study

• Authors: R. Piro, M. Fontana, F. Livrieri, F. Menzella, E. Casalini, S. Taddei, F. De Giorgi, N. Facciolongo
• Journal: Thoracic Cancer
• Published: 2021;12(6):981-984
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an asbestos-related and locally invasive tumor with poor prognosis. The acquisition of histological material is mandatory in order to establish a diagnosis. In this situation, the sampling of tissue is generally performed via a thoracoscopic pleural biopsy, either medically or surgically. The use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or transesophageal fine needle aspiration with an EBUS scope (EUS-B-FNA) of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report a rare case of MPM successfully diagnosed via EUS-B-FNA in a 49-year-old woman with an unusual presentation characterized by solid thickening in the right mediastinal pleura.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This article is a case report from a hospital pulmonology unit in Reggio Emilia, Italy. It described a 49-year-old woman with no tobacco use and no known asbestos exposure who was evaluated for fever, chest tightness and joint pain. A chest CT scan showed solid thickening of the right pleura that extended into the mediastinum, close to the esophagus. A PET scan showed intense uptake in that thickening, with a maximum value of 13. Because the tissue lay next to the esophagus, the doctors sampled it with a needle passed through the esophagus using an ultrasound bronchoscope (a technique called EUS-B-FNA). They used a 19-gauge needle and made three passes, and there were no complications. Microscope examination and special stains indicated epithelioid mesothelioma, clinical stage IIIB. The authors described this as the second published report of a pleural mesothelioma diagnosed only with EUS-B-FNA. They concluded that the method can be a valid diagnostic procedure in selected patients whose pleural thickening is favorably located. They added that thoracoscopic pleural biopsy keeps an undisputed role.

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: case report
• Who was studied: one 49-year-old woman, a non-smoker with no known asbestos exposure, treated at a pulmonology unit in Reggio Emilia, Italy
• Exposure: no known asbestos exposure reported; no fiber type or job is given
• Main results:
  • In the patient, chest CT showed solid thickening of the right pleura, extending into the mediastinum close to the esophagus
  • In the patient, PET showed intense uptake corresponding to the right pleural thickening, with a maximum standard uptake volume (SUV) of 13
  • Tissue was obtained from the pleural mass through the esophagus (EUS-B-FNA) with a 19-gauge needle, and the procedure ended without complications
  • The tumor cells stained positive for calretinin, WT1 and cytokeratin 5, and negative for p40, TTF1 and BerEp4
  • The findings in the patient indicated epithelioid mesothelioma, clinical stage IIIB (T4N1M0)
  • The authors stated this was the second published report of a pleural mesothelioma diagnosed only with EUS-B-FNA
• The authors' conclusion: The authors concluded that echo-endoscopy is a valid diagnostic procedure for mesothelioma in selected patients with a favorable location of pleural thickening. They also stated that the role of thoracoscopic pleural biopsy remains undisputed.

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, Endoscopy, Prognosis, Pleural Biopsy, Ultrasound, Pleura.

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