Minimally Invasive Mesothelioma Diagnosis from Lung Fluid

Minimally invasive mesothelioma diagnosis with lung fluid may be just as effective as a tissue biopsy.

That’s according to Australian mesothelioma researchers. Australia was once one of the biggest producers of asbestos and now has some of the highest mesothelioma rates in the world. It is also home to high-level mesothelioma research.

In the latest study, scientists ran a meta-analysis comparing surgical biopsy with a minimally invasive mesothelioma diagnosis tool called cytology.

Their conclusion is that surgery may not always be necessary to diagnose malignant mesothelioma.

Tissue Versus Lung Fluid

Malignant mesothelioma is a fatal cancer caused by exposure to asbestos. It is challenging to diagnose because the symptoms are often vague and similar to other less serious conditions.

Doctors typically use several tools to make a diagnosis. The primary method is to remove a small piece of the mesothelioma tumor and examine it under a microscope. Together with lung fluid and blood tests, this has been the gold standard for diagnosing mesothelioma.

But now the Australian scientists say a biopsy may not always be necessary. In a newly-published article, they contend that lung fluid testing by itself is accurate enough to make a minimally invasive mesothelioma diagnosis in most cases.

Cytology for Minimally Invasive Mesothelioma Diagnosis

Extra fluid in the space around the lungs (pleura) is a common side effect of mesothelioma. This pleural fluid often contains some free-floating mesothelioma cells. The type of test that looks for cancer cells in this fluid is called cytology.

Unlike a biopsy test, a cytology test is minimally invasive. Doctors can extract some lung fluid with a long needle, instead of having to take a tissue sample. The approach is endorsed for minimally invasive mesothelioma diagnosis by the International Academy of Cytology.

Cytology also gives doctors a safe and easy way to test for certain genetic mutations. Mesothelioma patients with mutations on the BAP1 or the CDKN2A genes may be candidates for clinical trials of gene-based treatments.

Testing lung fluid for these two genes can help doctors tell the difference between mesothelioma and certain non-cancer conditions.

The authors of the new report recommend that all mesothelioma doctors make these tests available to their patients. They say minimally invasive mesothelioma diagnosis helps patients avoid risks – such as pain and infection – of more invasive approaches.

Last year, researchers at Stockholm’s Karolinska University Hospital concluded that lung fluid testing might save lives. They said mesothelioma cells may show up in lung fluid before a tumor is even visible. Evaluating lung fluid could lead to earlier diagnosis.

Source:

Louw, A, et al, “Advances in pathological diagnosis of mesothelioma: what pulmonologists should know”, July 2019, Current Opinions in Pulmonary Medicine, pp. 354-361, https://insights.ovid.com/crossref?an=00063198-201907000-00005