[MRT, CT and sonography in the preoperative assessment of the primary tumor spread in malignant pleural mesothelioma]

Diagnosis of malignant pleural disease: Ultrasound as "a detective probe"

BACKGROUND

Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies.

METHODS

In this retrospective single-center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination.

RESULTS

In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day.

CONCLUSION

With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs.

Preoperative assessment and therapeutic options for patients with malignant pleural mesothelioma

Prompt medical evaluation and aggressive treatment can lead to prolonged survival or successful palliation of symptoms for patients with malignant pleural mesothelioma, but the window for implementing treatment is short. Clinical recognition of the cancer is confounded by numerous factors, including long latency between exposure to asbestos and expression of the disease, nonspecific nature of the presenting symptoms, rarity of the disease, a lack of experience in clinical diagnosis, and rapidly deteriorating clinical course after diagnosis. Heightened clinical suspicion and proper patient selection through accurate staging and pathologic identification are paramount to defining and delivering therapy for this rare, lethal cancer.

Diagnosis and staging of mesothelioma transthoracic ultrasound

Various techniques are used for diagnosing mesothelioma including clinical investigation, transthoracic ultrasound, X-ray, computed tomography (CT), sonographic support puncture and thorascoscopy with biopsy. Whereas ultrasound examination of a normal lung is of limited value, it can be very useful in identifying pleural pathological processes. The presence of pleural effusion can substantially enhance the usefulness of ultrasound investigations: the liquid of the pleural effusion acts as an acoustic window and can enable the detection of intrapleural and intrapulmonal processes. Highly soluble transducers can be used to visualise pathological findings at the chest wall, enabling the recognition of pleural effusions and the diagnosis of pleural thickening, tumour tissue and abscesses. Further evidence for diagnosis can be obtained with ultrasound-guided puncture, using one of three techniques: sonographic supported puncture, sonographic-guided puncture without puncture assistance, and sonographic-guided puncture with puncture assistance. Complications such as bleeding, infection and local tumour cell propagation can arise.

Real-time chest ultrasonography: a comprehensive review for the pulmonologist

This review discusses real-time pulmonary ultrasonography (US) for the practicing pulmonologist. US supplements chest radiography and chest CT scanning. Major advantages include bedside availability, absence of radiation, and guided aspiration of fluid-filled areas and solid tumors. Pulmonary vessels and vascular supply of consolidations may be visualized without contrast. US may help to diagnose conditions such as pneumothorax, hemothorax, pleural or pericardial effusion, pneumonia, and pulmonary embolism in the critically ill patient who is in need of bedside diagnostic testing. The technique of US, which is cost-effective compared to CT scanning and MRI, may be learned relatively easily by the pulmonologist.