Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions

Our plain-English summary of Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions, by A. Cantó, R. Guijarro, A. Arnau, et al (The Thoracic and Cardiovascular Surgeon, 1997).

The study

• Authors: A. Cantó, R. Guijarro, A. Arnau, J. Galbis, M. Martorell, R. García Aguado
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 1997;45(1):16-9
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Between 1985 and 1994 46 of 662 patients examined by thoracoscopy for secondary malignant pleural effusion were diagnosed to have diffuse malignant pleural mesothelioma. Mean patient age was 59 years, with a male: female ratio of 5:1. The right hemithorax was more frequently involved than the left (55% versus 45%). Pleural fluid cytology revealed malignancy in 61.5% of cases. All patients were treated thoracoscopically by talc pleurodesis. Mean patients survival was 9.4 months. Survival after one, two, and 5 years was 37.5%, 12.5%, and 5%, respectively. The characteristics of mesothelioma and pleural effusion evident in thoracoscopy and their diagnostic relevance are discussed. We suggest talc instillation as the sole therapeutic maneuver in evolutioned cases, since the literature and our own experience indicate that survival is not significantly prolonged by more aggressive surgical approaches.

In plain English

This retrospective review covered 46 patients at Valencia University General Hospital, Spain, diagnosed from 1985 to 1994 with pleural mesothelioma and fluid around the lung (pleural effusion), and examined with a camera inserted into the chest (thoracoscopy). Asbestos exposure was not reported. Mean age was 59 years. 72% were reported as men, but the article's printed counts of 23 men and 13 women do not add up to 46. Fluid testing found cancer cells in 28 of 46 cases (61%), but only 30% of these were first identified as mesothelioma. None was judged limited or early, so all received talc pleurodesis, a talc treatment to stop fluid returning. None received radiotherapy or chemotherapy. Mean survival from provisional diagnosis was 9.4 months. Survival at one, two and five years was given as 37.5%, 12.5% and 5% (15, 4 and 2 patients); these counts do not match the percentages out of 46. The authors suggested talc as the only treatment in advanced cases. They noted their survival was poorer than in surgical series, but that their whole group was analysed regardless of disease stage.

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 (case series) of patients diagnosed with pleural mesothelioma at one hospital
• Who was studied: 46 patients with pleural mesothelioma and pleural effusion examined by thoracoscopy at Valencia University General Hospital, Spain, 1985 to 1994. They came from 58 mesothelioma patients, after excluding 12 without effusion or thoracoscopy. The 46 were 7% of 662 thoracoscopies for secondary malignant pleural effusion. Mean age was 59 years (range 39 to 75). They were reported as 72% male and 28% female, although the printed counts of 23 males and 13 females do not add up to 46.
• Main results:
  • Pleural fluid cytology found malignant cells in 28 of the 46 mesothelioma cases (61%). Only 30% of these were initially classified as mesothelioma; most of the rest were attributed mainly to adenocarcinoma (60%).
  • Histological types among the 46 cases: 21 (45.6%) epithelial, 11 (23.9%) mixed, 4 (8.6%) sarcomatous, 10 (21.7%) uncertain
  • None of the 46 cases was diagnosed as limited or incipient, so all received talc pleurodesis (43 during the diagnostic thoracoscopy, 3 during a second one). No patient received radiotherapy or chemotherapy.
  • Mean survival from the time of provisional diagnosis was 9.4 months (standard deviation 11.3)
  • Survival at one, two and five years was reported as 37.5%, 12.5% and 5% (15, 4 and 2 patients). These counts do not give these percentages out of 46, and the article does not explain the denominators.
  • Mean survival by histological type: epithelial 11.0 months (median 9), mixed 10.2 months (median 7), sarcomatous 5.8 months (median 3.5)
  • Mesothelioma affected the right side in 25 cases (54%), the left in 21 (46%), and both sides in none
  • Hyaluronic acid was detected in the pleural fluid in only 20% of cases (9 of 46)
  • Early lesions showed a statistically significant tendency (p less than 0.05) to involve the visceral pleura first
• The authors' conclusion: The authors suggested talc instillation as the sole treatment in advanced cases, stating that the literature and their own experience indicate that more aggressive surgery does not significantly prolong survival. They also concluded that thoracoscopy was useful for diagnosis, for assessing operability and for palliative pleurodesis, and that the nodules seen at thoracoscopy were not specific to mesothelioma.
• Limitations the authors state:
  • Survival was clearly poorer than in surgical series, but the whole group of patients was evaluated regardless of disease stage
  • Comparing published treatment studies of pleural mesothelioma is difficult or impossible because the protocols differ

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Thoracoscopy, Hemithorax, Fluid Cytology, Talc Pleurodesis, Mesothelioma, Talc.

Related studies

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• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions — S. Terashita, H. Kawachi, et al. (2019)

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