Staging malignant pleural mesothelioma: additional investigation may not improve accuracy

Our plain-English summary of Staging malignant pleural mesothelioma: additional investigation may not improve accuracy, by D.G. West, W.S. Walker (European Journal of Cardio-thoracic Surgery, 2011).

The study

• Authors: D.G. West, W.S. Walker
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2011;39(5):800; author reply 800-1
• Type of article: Letter, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This item is a letter to the editor, not a research article. It was written by two surgeons from hospitals in Glasgow and Edinburgh, Scotland, in response to an earlier study by Nakas and colleagues on staging malignant pleural mesothelioma. That earlier study had found poor agreement between the stage estimated before surgery and the stage found on examining tissue after surgery. The letter writers described their own experience. Between 2004 and 2008 they performed extrapleural pneumonectomy in 17 patients with biopsy-proven malignant pleural mesothelioma, and all of these patients had cervical mediastinoscopy plus CT and MRI of the chest before surgery. Even with routine MRI, only 64.3% of their clinical T staging matched the final pathology. In addition, 17.6% of their patients were found at surgery to have N2 lymph node disease that had not been detected beforehand. The authors concluded that further pre-operative staging with current techniques may offer limited benefit. They reported not seeing a significant improvement from adding routine MRI or mediastinoscopy. The letter gives no information on asbestos exposure. A reply from Nakas and Waller follows it in the text.

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: Letter to the editor describing the authors' own surgical experience (a small case series), in response to a study by Nakas et al.
• Who was studied: 17 patients with biopsy-proven malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP) between 2004 and 2008. All had cervical mediastinoscopy and CT and MRI of the chest. The authors are from hospitals in Glasgow and Edinburgh, Scotland.
• Main results:
  • Among the authors' patients, despite routine MRI, only 64.3% of clinical T staging matched the final pathology. The letter compares this with 44% in the Nakas et al. series.
  • 17.6% of the authors' patients were upstaged from clinical N0 or N1 to pathological N2 (occult N2 disease) at resection. The letter compares this with 25 patients (15.2%) in the Nakas et al. series.
  • The authors reported not seeing a significant improvement in staging from adding routine MRI or mediastinoscopy.
• The authors' conclusion: The authors concluded that their experience suggests there may be limited benefit to further pre-operative staging with current techniques. They wrote that targeting radical treatment remains limited by the accuracy of current staging.

Topics

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

Medical terms in this study, explained in our Lexicon: Staging, Pleural Mesothelioma.

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