Diagnostic Value of Computed Tomography Imaging Features in Malignant Pleural Mesothelioma.
Aged
Aged, 80 and over
Breast Neoplasms
/ pathology
Carcinoma, Squamous Cell
/ diagnostic imaging
Female
Humans
Lung Neoplasms
/ pathology
Male
Mesothelioma, Malignant
/ diagnostic imaging
Middle Aged
Neoplasms, Unknown Primary
/ pathology
Pleural Effusion, Malignant
/ diagnostic imaging
Pleural Neoplasms
/ diagnostic imaging
Retrospective Studies
Thoracentesis
Thoracoscopy
Tomography, X-Ray Computed
CT scan
Malignant pleural effusion
Malignant pleural mesothelioma
Journal
Respiration; international review of thoracic diseases
ISSN: 1423-0356
Titre abrégé: Respiration
Pays: Switzerland
ID NLM: 0137356
Informations de publication
Date de publication:
Historique:
received:
19
04
2019
accepted:
06
09
2019
pubmed:
28
10
2019
medline:
7
4
2021
entrez:
28
10
2019
Statut:
ppublish
Résumé
Medical history, thoracentesis, and imaging features are usually the first steps in the investigation of a possible malignant pleural effusion (MPE). Unfortunately, the diagnostic yield of thoracentesis in this situation is suboptimal even if the procedure is repeated, especially in the context of malignant pleural mesothelioma (MPM). The next step for confirming the diagnosis, if clinically appropriate, is thoracoscopy, but not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only. Our objective was to evaluate the diagnostic value of the medical history and imaging features in MPM. We reviewed the imaging and medical charts of 92 patients with a final diagnosis of MPE included in our prospective medical thoracoscopy database. The clinical characteristics and imaging features of patients with primary MPE were compared with those of patients with secondary MPE. Male sex (82 vs. 59%, p = 0.02), asbestos exposure (58 vs. 10%, p < 0.001), and mediastinal (68 vs. 33%, p = 0.04), diaphragmatic (75 vs. 31%, p = 0.001) and circumferential pleural thickening (55 vs. 19% p = 0.001) were significantly more frequent in MPM patients. In a multivariate linear regression model, only asbestos exposure (OR 11.2; 95% CI 3.4-36.9) and circumferential pleural thickening (OR 4.7; 95% CI 1.6-13.9) were significantly associated with a diagnosis of MPM. In situations where it is impossible to obtain adequate pleural samples to differentiate MPM from a secondary pleural malignancy, the combination of circumferential pleural thickening and a history of asbestos exposure may be sufficient to make a clinical diagnosis.
Sections du résumé
BACKGROUND
BACKGROUND
Medical history, thoracentesis, and imaging features are usually the first steps in the investigation of a possible malignant pleural effusion (MPE). Unfortunately, the diagnostic yield of thoracentesis in this situation is suboptimal even if the procedure is repeated, especially in the context of malignant pleural mesothelioma (MPM). The next step for confirming the diagnosis, if clinically appropriate, is thoracoscopy, but not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only.
OBJECTIVES
OBJECTIVE
Our objective was to evaluate the diagnostic value of the medical history and imaging features in MPM.
METHODS
METHODS
We reviewed the imaging and medical charts of 92 patients with a final diagnosis of MPE included in our prospective medical thoracoscopy database. The clinical characteristics and imaging features of patients with primary MPE were compared with those of patients with secondary MPE.
RESULTS
RESULTS
Male sex (82 vs. 59%, p = 0.02), asbestos exposure (58 vs. 10%, p < 0.001), and mediastinal (68 vs. 33%, p = 0.04), diaphragmatic (75 vs. 31%, p = 0.001) and circumferential pleural thickening (55 vs. 19% p = 0.001) were significantly more frequent in MPM patients. In a multivariate linear regression model, only asbestos exposure (OR 11.2; 95% CI 3.4-36.9) and circumferential pleural thickening (OR 4.7; 95% CI 1.6-13.9) were significantly associated with a diagnosis of MPM.
CONCLUSION
CONCLUSIONS
In situations where it is impossible to obtain adequate pleural samples to differentiate MPM from a secondary pleural malignancy, the combination of circumferential pleural thickening and a history of asbestos exposure may be sufficient to make a clinical diagnosis.
Identifiants
pubmed: 31655816
pii: 000503239
doi: 10.1159/000503239
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28-34Informations de copyright
© 2019 S. Karger AG, Basel.