Staging algorithm for diffuse malignant pleural mesothelioma
Marcin Zielinski 1*,
Jolanta Hauer 1,
Lukasz Hauer 1,
Juliusz Pankowski 1,
Tomasz Nabialek 1,
Artur Szlubowski 1
1 Pulmonary Hospital, Zakopane, Poland
* To whom correspondence should be addressed. E-mail: marcinz{at}mp.pl.
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Abstract |
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An algorithm of preoperative mediastinal nodal staging with endobronchial/endoesophageal ultrasonography (EBUS/EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) combined with laparoscopy/peritoneal lavage and cytology was analyzed to establish the realistic criteria for radical multimodality treatment of malignant pleural mesothelioma (MPM). The algorithm included computed tomography (CT), thoracoscopy with multiple pleural biopsies and talc pleurodesis, EBUS/EUS and one-stage TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid. 42 patients were diagnosed from 1 January 2004 to 31 December 2008. There were 16 women and 26 men in ages ranging from 43 to 77 (mean 57.8); 31 epithelioid, 2 sarcomatoid and 9 biphasic type MPM. 21/42 patients were considered possible candidates for multimodality treatment. 3 patients who received neoadjuvant chemotherapy were excluded from this study. EBUS/EUS was performed to stage the mediastinal nodes. In 3/18 patients metastatic nodes were discovered. In the rest of the 15 patients simultaneous TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid were performed. In 3 patients TEMLA was positive, in 6 patients laparoscopy was positive and in 2 patients both TEMLA and laparoscopy were positive. Finally, 4/42 (9.5%) patients underwent thoracotomy with 1 exploration (chest wall infiltration) and 3 pleuropneumonectomies with the subsequent chemo- and radiotherapy. The proposed algorithm of preoperative staging spared the majority of MPM patients from futile surgery. Keywords: Malignant mesothelioma; Pleura; Staging
