Simultaneous Use of Endobronchial and Endoscopic Ultrasound Guidance as Primary Tools in the Diagnosis of Malignant Pleural Mesothelioma

Our plain-English summary of Simultaneous Use of Endobronchial and Endoscopic Ultrasound Guidance as Primary Tools in the Diagnosis of Malignant Pleural Mesothelioma, by B. Mankidy, J. Sparkman, S. Boddu, et al (Curēus, 2022).

The study

• Authors: B. Mankidy, J. Sparkman, S. Boddu, Q. Huang, M. Sharma
• Journal: Curēus
• Published: 2022;14(12):e32110
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is related to exposure to asbestos. It is insidious in nature and is generally diagnosed at an advanced stage. MPM is aggressive and portends a poor prognosis. Definitive diagnosis is usually established by obtaining pathological samples of the pleura by medical or surgical thoracoscopy. However, these procedures are invasive and carry a risk of seeding of biopsy sites with tumors. We herein report an infrequently encountered case of simultaneous use of endobronchial ultrasound and endoscopic ultrasound-guided biopsy of malignant pleural mesothelioma in a 48-year-old female patient.

Copyright © 2022, Mankidy et al.

In plain English

This case report described one 48-year-old woman diagnosed with malignant pleural mesothelioma. She had hypertension, obesity, heart failure and a 30 pack-year smoking history, and seven months of worsening breathlessness on exertion. The article does not report asbestos exposure for her. It states she had no occupational exposure to dust or toxic inhalation. Scans showed enlarged chest lymph nodes and a moderate right pleural effusion, but fluid drained from the chest (thoracentesis) was negative for cancer cells. In one session, doctors took needle biopsies of lymph nodes beside the esophagus using endoscopic ultrasound (EUS) and of lymph nodes near the airways using endobronchial ultrasound (EBUS). Samples from the para-esophageal nodes and one airway node (station 10R) showed metastatic malignant mesothelioma, epithelioid type. Surgical procedures were judged unnecessary because they would not change management, and chemotherapy with cisplatin, pemetrexed and bevacizumab was started. The authors concluded that, in selected cases with enlarged mediastinal lymph nodes, EBUS and EUS can provide samples for diagnosis and staging less invasively than conventional techniques.

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 (single patient)
• Who was studied: One 48-year-old woman with hypertension, obesity, congestive heart failure with preserved ejection fraction and a 30 pack-year cigarette smoking history. She came to a pulmonary clinic with seven months of worsening shortness of breath on exertion. The article does not give the place or dates of care.
• Exposure: The article does not report any asbestos exposure for this patient. It states she had no occupational exposure to dust or toxic inhalation. Asbestos is mentioned only as a general association of the disease.
• Main results:
  • Chest CT showed multiple enlarged right internal thoracic lymph nodes and a moderate right pleural effusion.
  • PET/CT showed intensely hypermetabolic enlarged right hilar, right cardiophrenic and periesophageal lymph nodes.
  • Thoracentesis with cytology (examining the drained pleural fluid) was negative for malignancy.
  • An EUS-guided biopsy of para-esophageal lymph nodes was followed, in the same session, by EBUS-guided biopsy of station 10R and 11R lymph nodes.
  • Pathology showed metastatic malignant mesothelioma, epithelioid type, in samples from the para-esophageal and station 10R lymph nodes.
  • Immunohistochemical stains were positive for calretinin, WT 1, D2-40 and cytokeratin 5/6.
  • The molecular profile was consistent with malignant pleural mesothelioma, but none of the molecular alterations found were targetable by treatment.
  • Mediastinoscopy and video-assisted thoracic surgery were judged not necessary because they would not change management.
  • Palliative chemotherapy with cisplatin, pemetrexed and bevacizumab was started.
• The authors' conclusion: The authors concluded that, in selected cases of possible malignant pleural mesothelioma with mediastinal lymph node enlargement, EBUS and EUS can provide samples for pathological diagnosis and staging in a less invasive way than conventional techniques.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Pleural Mesothelioma, Prognosis, Pleura, Thoracoscopy, Biopsy.

Related studies

• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)
• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)
• Endoscopic ultrasound-guided fine needle aspiration of a pericardial mass — P. Somani, M. Sharma, et al. (2016)
• Confocal Laser Endomicroscopy as a Guidance Tool for Pleural Biopsies in Malignant Pleural Mesothelioma — L. Wijmans, P. Baas, et al. (2019)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)

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