Swedish researchers say more people might survive mesothelioma if doctors paid more attention to lung fluid analysis in making their diagnosis.
The only way to definitely diagnose mesothelioma is to examine cells under a microscope. But pathologists at Karolinska University Hospital in Stockholm say tissue biopsy happens too late.
Lung fluid starts to collect much earlier in the disease process. The Swedish team says lung fluid analysis (cytology) could give doctors an earlier indication of mesothelioma. That could lead to earlier diagnosis and better survival.
Diagnosing Malignant Mesothelioma
There are many signs of malignant mesothelioma. Coughing, chest pain, and shortness of breath are some of the most common. When these symptoms occur in someone who has worked around asbestos, that is another red flag.
Unfortunately, most of the outward signs of mesothelioma do not show up until the disease is in an advanced stage. By that time, it may be too late for treatment to work well.
Lung fluid analysis is another way to find and examine cancer cells. About 90 percent of mesothelioma patients develop a buildup of fluid around one lung. This is one of the earliest signs of mesothelioma. It can happen even before the tumor is big enough to biopsy.
Doctors often use lung fluid analysis along with other diagnostic tools. The Swedish team says it should play a more central role in planning mesothelioma treatment.
Planning Mesothelioma Treatment Based on Lung Fluid Analysis
Studies show earlier mesothelioma diagnosis improves the odds of survival. Earlier diagnosis allows a patient to start treatments earlier. A smaller mesothelioma tumor is easier for a surgeon to remove. It may also be more responsive to chemotherapy, radiotherapy, and immunotherapy.
Lung fluid analysis alone will not show if a person has mesothelioma. But Dr. Anders Hjerpe and his colleagues say it is a good place to start. Lung fluid is easier to access than a tumor. A surgeon extracts the fluid through the chest wall with a needle. This can be done even before a biopsy.
If lung fluid keeps building up – especially if it happens on just one side – Hjerpe says doctors should always suspect mesothelioma.
There are limits to what lung fluid analysis can tell. For instance, it cannot show how widespread the mesothelioma is. But in combination with biopsy, it can make mesothelioma diagnosis more accurate.
“Early detection of malignant mesothelioma by integrating cytology and molecular approaches has high sensitivity and positive predictive value and has a major impact on patient survival,” the report concludes. “Thus, a conclusive positive malignant mesothelioma cytology should lead to treatment without delay.”
Hjerpe, A, et al, “Integrative approach to cytologic and molecular diagnosis of malignant pleural mesothelioma”, June 2020, Translational Lung Cancer Research, http://tlcr.amegroups.com/article/view/41065/html