The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma

Our plain-English summary of The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma, by M.R. Ghigna, A. Crutu, V. Florea, et al (Cytopathology, 2016).

The study

• Authors: M.R. Ghigna, A. Crutu, V. Florea, S. Soummer-Feulliet, P. Baldeyrou
• Journal: Cytopathology
• Published: 2016;27(4):284-8
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aims of the present study were to investigate the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of malignant pleural mesothelioma (MPM), and to identify specific clinical settings in which this procedure can be recommended.

Methods: We retrospectively reviewed the clinical and pathological files of patients having undergone EBUS-TBNA from February 2011 to October 2014 to investigate thoracic lesions. Among 736 patients, we identified four of them with a diagnosis of MPM achieved primarily through EBUS-TBNA. The diagnosis was made on formalin-fixed paraffin-embedded cell blocks, by checking the expression of mesothelial and carcinomatous-specific markers.

Results: In all patients, the collected tissue was adequate, and the histological analysis in association with immunohistochemistry led us to the diagnosis of malignant pleural mesothelioma. In three patients, the diagnosis of mesothelioma was clinically suspected, as patients presented with diffuse pleural thickening. In two patients, videothoracoscopy was not possible owing to the 'dry' presentation of the pleural disease and the site of thickening. In this setting, EBUS-TBNA was considered, at a multidisciplinary consensus meeting, as the most adequate available method to obtain a histological diagnosis.

Conclusion: EBUS-TBNA may be a valuable diagnostic technique in the field of pleural pathology in selected clinical settings. More specifically 'dry' mesothelioma forming para-tracheal nodules or masses not accessible by surgery or by computed tomography/ultrasonogaphy-guided needle biopsy constitutes a good indication to perform EBUS-TBNA.

© 2015 John Wiley & Sons Ltd.

In plain English

This was a retrospective review of a small series of patients at the Marie Lannelongue Surgical Centre in Le Plessis-Robinson, France. The authors asked whether endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) can be used to diagnose malignant pleural mesothelioma. In this procedure, a needle passed through the airway collects cell samples. Between February 2011 and October 2014, 736 patients had the procedure to investigate chest nodules. Four of them, aged 49 to 75, were diagnosed with pleural mesothelioma. In all four, the samples led to a diagnosis of epithelioid mesothelioma. The diagnosis rested on how the cells looked and on stains: the cells showed markers of mesothelial cells but not the markers tested for carcinoma. None of the four had complications. In three, the clinical picture had suggested mesothelioma. Later surgical biopsies confirmed the diagnosis in two patients, and in a third when the disease came back about a year after chemotherapy. The authors concluded that EBUS-TBNA can be a valuable way to diagnose mesothelioma in specific settings. Examples are 'dry' mesothelioma (without fluid) lying near the airways, or disease involving the lymph nodes in the middle of the chest. The article does not report the patients' asbestos exposure.

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 clinical and pathology records; a small case series ('mini-series') of four patients
• Who was studied: Four patients aged 49, 61, 74 and 75 diagnosed with pleural mesothelioma. They were found among 736 patients who underwent EBUS-TBNA to explore thoracic nodules between February 2011 and October 2014 at a surgical centre in Le Plessis-Robinson, France.
• Main results:
  • EBUS-TBNA samples led to a mesothelioma diagnosis in all four patients. Table 1 lists each as epithelioid mesothelioma.
  • None of the four patients had complications after the EBUS procedure.
  • The clinical presentation suggested mesothelioma in three of the four patients. The fourth had a posterior mediastinal mass and right lung nodules without pleural thickening or effusion.
  • The tumour cells stained for the mesothelial markers CK5/6, calretinin and WT-1.
  • The tumour cells did not express the carcinoma-associated markers polyclonal CEA, TTF-1 or p63.
  • In two of the four patients, a later videothoracoscopy with surgical biopsy confirmed the malignant mesothelioma diagnosis.
  • The patient with 'dry' mesothelioma presenting as a mediastinal mass had chemotherapy and a quick remission. About 1 year later the disease recurred, and a surgical biopsy confirmed mesothelioma.
• The authors' conclusion: The authors concluded that EBUS-TBNA can be a valuable means of diagnosing mesothelioma in two settings: 'dry' mesothelioma presenting as localised pleural thickening near the bronchial tree, or mediastinal nodal involvement. They also thought it could be useful for staging and for evaluating local recurrences.

Topics

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

Medical terms in this study, explained in our Lexicon: Ultrasound, Pleural Mesothelioma, Cell Block, Immunohistochemistry, Mesothelioma, Diffuse Pleural Thickening, Pathology, Needle Biopsy.

Related studies

• 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)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• 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)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)

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