A minimally invasive method for cancer staging could prevent unnecessary surgery for malignant mesothelioma.
The method involves putting a needle into the chest behind the breast bone. This area is called the mediastinum.
The mediastinum contains critical lymph nodes. The presence or absence of cancer cells in these nodes can help determine whether a patient needs surgery for malignant mesothelioma.
Now, a group of Canadian doctors say an ultrasound-guided needle biopsy procedure can provide as much information as more invasive options with less risk and pain.
Staging Helps Direct Surgery for Malignant Mesothelioma
Most mesothelioma patients receive chemotherapy. If the patient is healthy enough and the cancer has not spread, the patient may also have surgery for malignant mesothelioma.
Some patients have a lung removed along with their diseased pleural lining. Others have a more conservative type of surgery that leave the lungs in place.
One way doctors determine who would benefit from surgery for malignant mesothelioma is by examining cells from their lymph nodes. The more lymph nodes that contain mesothelioma cells, the more advanced the cancer is.
The new Canadian study focused on a minimally-invasive but precise way to check for cancer cells in the lymph nodes.
Ultrasound Guidance for Mesothelioma Staging
The procedure is called endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
During EBUS-TBNA, the surgeon uses ultrasound to guide a biopsy needle into the space between the sternum and the spinal column.
Pleural mesothelioma tumors may shed cells into lymph nodes in this region. EBUS-TBNA removes some lymph node cells for testing.
It can take the place of a bigger, riskier procedure that involves placing a camera into the same area.
Using EBUS-TBNA to Plan Surgery for Malignant Mesothelioma
The new study looked back at the cases of 48 patients who had surgery for malignant mesothelioma. Patients were diagnosed between 2012 and 2014. More than 70 percent of the patients had epithelioid mesothelioma, the most common subtype.
EBUS-TBNA showed that 35 percent of the patients had Stage 2 or 3 mesothelioma. Although it was not very good at determining which patients definitely had mesothelioma, EBUS-TBNA was 100 percent accurate in ruling out the asbestos cancer.
Just as importantly, it helped show which patients were not good surgical candidates.
“EBUS-TBNA mediastinal lymph node staging prevented unnecessary surgery in 18.8% (9/48 patients) by detection of N2/N3 disease (8 patients) and metastatic secondary malignancy (1 patient),” writes lead author Kasia Czarnecka-Kujawa. “There were no EBUS-TBNA related complications.”
The researchers conclude that the EBUS-TBNA “may impact significantly management of patients with malignant pleural mesothelioma” by detecting metastatic cancer.
Preventing surgery for malignant mesothelioma when it is unlikely to help can prevent surgery-related complications and deaths.
Czarnecka-Kujawa, K, et al, “Endobronchial ultrasound-guided transbronchial needle aspiration mediastinal lymph node staging in malignant pleural mesothelioma”, February 2019, Journal of Thoracic Disease, pp. 602-612, http://jtd.amegroups.com/article/view/26697/20060