Hashimoto Masaki, Sato Ayuko, Kuroda Ayumi, Nakamura Akifumi, Nakamichi Toru, Kondo Nobuyuki, Yuki Michiko, Nabeshima Kazuki, Tsujimura Tohru, Hasegawa Seiki
Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nisinohomiya, Hyogo, 6638501, Japan.
Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
Gen Thorac Cardiovasc Surg. 2020 Aug;68(8):820-827. doi: 10.1007/s11748-020-01295-5. Epub 2020 Jan 24.
Pleural biopsy through video-assisted thoracic surgery (VATS pleural biopsy) is the most reliable diagnostic procedure for malignant pleural mesothelioma (MPM). However, definitive diagnosis of MPM is occasionally difficult to establish. This study aims to investigate clinicopathological features of MPM patients who failed diagnosis by the first VATS pleural biopsy.
Four hundred consecutive patients with suspected MPM who received VATS pleural biopsy between March 2004 and July 2017 were enrolled in this retrospective study. Patients, whose histological diagnoses were not definitive in the first VATS pleural biopsy, were followed up as atypical mesothelial proliferation (AMP) or non-specific pleuritis (NSP). Re-examination was performed in cases strongly suspected of having MPM.
Of the 400 patients, 267 (66.8%) were pathologically diagnosed with MPM, 25 with metastatic carcinoma and 6 with benign pleural disease by the first VATS pleural biopsy. Of the remaining 102 patients diagnosed with AMP or NSP, 10 patients (9.8%) were subsequently diagnosed with MPM. Analysis of the clinical course revealed that only insufficient tissue for diagnosis was obtained via VATS pleural biopsy in all cases and that it was caused by very early stage without visible tumour in 4 patients, intrathoracic inflammation in 4 and desmoplastic MPM in 2.
In our review, 9.8% of patients diagnosed with AMP or NSP in first VATS pleural biopsy were subsequently diagnosed with MPM due to insufficient tissue for diagnosis. Definitive diagnosis via VATS pleural biopsy is sometimes challenging in following situation; very early stage, intrathoracic inflammation and desmoplastic MPM.
通过电视辅助胸腔镜手术进行胸膜活检（VATS胸膜活检）是诊断恶性胸膜间皮瘤（MPM）最可靠的方法。然而，MPM的明确诊断有时难以确立。本研究旨在调查首次VATS胸膜活检未能确诊的MPM患者的临床病理特征。
本回顾性研究纳入了2004年3月至2017年7月期间连续接受VATS胸膜活检的400例疑似MPM患者。首次VATS胸膜活检组织学诊断不明确的患者，作为非典型间皮细胞增生（AMP）或非特异性胸膜炎（NSP）进行随访。对高度怀疑患有MPM的病例进行复查。
400例患者中，首次VATS胸膜活检病理诊断为MPM的有267例（66.8%），转移性癌25例，良性胸膜疾病6例。其余102例诊断为AMP或NSP的患者中，有10例（9.8%）随后被诊断为MPM。临床病程分析显示，所有病例通过VATS胸膜活检获得的诊断组织均不足，其中4例是由于疾病处于极早期无可见肿瘤，4例是由于胸腔内炎症，2例是由于促结缔组织增生性MPM。
在我们的回顾中，首次VATS胸膜活检诊断为AMP或NSP的患者中有9.8%因诊断组织不足而随后被诊断为MPM。在以下情况下，通过VATS胸膜活检进行明确诊断有时具有挑战性：极早期、胸腔内炎症和促结缔组织增生性MPM。
