Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma

Our plain-English summary of Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma, by F. Chen, A. Yoshizawa, K. Okubo, et al (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: F. Chen, A. Yoshizawa, K. Okubo, H. Date
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;12(6):1060-2
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To confirm the risk of chest wall tract metastases following chest wall intervention for malignant pleural mesothelioma (MPM), we reviewed our institutional experience. Between 2006 and 2010, 14 patients with MPM underwent chest wall intervention for diagnosis in Kyoto University Hospital. Seven of them underwent extrapleural pneumonectomy (EPP) after the diagnosis, while seven did not undergo EPP. All patients did not show any macroscopic abnormalities around the biopsy sites suggesting chest wall tract metastases. In the seven EPP patients, tissues including the chest wall tract, which were removed were investigated pathologically for possible metastases. In two of these seven patients, diffuse extension of MPM along the chest wall tract was pathologically confirmed. In these two patients, the period between pleural biopsy and EPP was relatively short in comparison with that in the other five patients. Despite the small number of cases, the importance of resection of the chest wall tract for the diagnostic intervention might be implied at EPP.

In plain English

This case report retrospectively reviewed 14 patients with malignant pleural mesothelioma who had a diagnostic chest wall procedure at Kyoto University Hospital, Japan, in 2006 to 2010. For 13, this was a thoracoscopic pleural biopsy. The article does not discuss asbestos exposure. No patient had visible abnormalities at the biopsy site suggesting tumor spread along the instrument path (chest wall tract). Seven later had extrapleural pneumonectomy (EPP), and the removed tract tissue was examined microscopically. In two of these seven, mesothelioma had spread diffusely along the tract, to the muscle between the ribs in one and just beneath the skin in the other. These two had EPP 14 and 19 days after biopsy, against a median of 31 days stated in the text (the table's figures give 34). Both died within one year after EPP with tumor recurrence. The seven patients who did not have EPP showed no signs or symptoms of tract spread, but no tissue was examined. No patient received preventive radiation to the tract. The authors concluded that, despite few cases, removing the tract during EPP might be important.

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 one hospital's patients, published as a case report (case series)
• Who was studied: 14 patients with malignant pleural mesothelioma (MPM) at Kyoto University Hospital, Japan, 2006 to 2010. The table lists 11 men and 3 women, aged 48 to 84. Seven later had extrapleural pneumonectomy (EPP) and seven did not.
• Exposure: A diagnostic chest wall procedure: video-assisted thoracoscopic pleural biopsy through one port in 13 patients, and an ultrasound-guided biopsy in one patient (per the table). Asbestos exposure is not reported.
• Main results:
  • None of the 14 patients showed visible abnormalities around the biopsy sites suggesting chest wall tract metastases.
  • In 2 of the 7 patients who had EPP (patients 1 and 4), microscopic examination confirmed diffuse spread of mesothelioma along the chest wall tract.
  • In patient 1 the tumor reached the intercostal muscle (the muscle between the ribs). In patient 4 it reached just beneath the derma (skin).
  • The two patients with tract spread had EPP 14 and 19 days after biopsy. The text states a median biopsy-to-EPP interval of 31 days for the EPP patients, but the seven intervals listed in Table 1 (14, 28, 39, 19, 42, 48, 34 days) give a median of 34 days.
  • Both patients with tract spread died within one year after EPP, with tumor recurrence in the pericardium and peritoneum.
  • The seven patients who did not have EPP showed no signs or symptoms of chest wall tract metastases, but no tissue samples were examined. One of them (patient 9) had a surgical procedure during which disseminated disease was found, so resection was not done.
• The authors' conclusion: The authors concluded that, despite the small number of cases, the results might suggest that removing the diagnostic chest wall tract during EPP is important.
• Limitations the authors state:
  • Because the number of cases was small, the authors could not work out how tumor spread along the tract relates to how aggressive the tumor is.
  • No patient received preventive chest wall radiation, so the authors drew no conclusions about that treatment.
  • Tract tissue was examined only in patients who had EPP. No tissue was obtained from the seven patients who did not have EPP.
  • The authors said results on tract removal and on EPP itself should be interpreted with caution, because the survival benefit of surgery for MPM has been questioned.

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, Extrapleural Pneumonectomy (EPP), Biopsy, Pleural Biopsy.

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