Pleural effusion, or buildup of fluid around the lungs, can be caused by several different conditions and cancers, including malignant pleural mesothelioma. When doctors are unable to make a definitive diagnosis of mesothelioma or to determine its extent from fluid samples and imaging studies alone, an open surgery of the chest (thoracic surgery) may be recommended. But a team of Mayo Clinic doctors writing in the medical journal Chest say minimally invasive outpatient medical thoracoscopy offers a feasible alternative to surgery for exploring the chest cavity in people with suspected mesothelioma.
The study focused on 51 patients, most of whom had undiagnosed exudative (leaking) pleural effusion. Using a special camera called a thoracoscope to examine the chest cavity, doctors found no apparent problems that would account for the effusion in 5.9% of patients. More than half of patients had pleural inflammation, 19 had small tumors or “studding” on the pleura, 2 had pleural thickening, and one had a defect on the diaphragm. Although 45.1% of patients were given a diagnosis of “non-specific pleuritis”, 27.5% were found to have pleural mesothelioma.
Most notably, the doctors report very few complications and no significant cases of heart or breathing problems after the thoracoscopic procedure, both of which can be concerns for mesothelioma patients who undergo more invasive thoracic surgery. None of the patients in the study died after having a thoracoscopy. The authors concluded that thoracoscopy can be “successfully integrated into a busy tertiary referral medical center” as long as pulmonologists and thoracic surgeons work together to make it happen. “Outpatient medical thoracoscopy may provide patients a more convenient alternative to an inpatient surgical approach in the diagnosis of undiagnosed exudative pleural effusions while maintaining a high diagnostic yield and excellent safety,” they write.
The fact that mesothelioma is such a rare cancer can make it harder to get a diagnosis. Many physicians have never encountered the so-called asbestos cancer, whose early symptoms can be similar to a number of benign conditions. Patients with a history of asbestos exposure who suspect they may have mesothelioma are advised to get an opinion from an experienced mesothelioma physician.
Depew, ZS, et al “Feasibility and Safety of Outpatient Medical Thoracoscopy at a Large Tertiary Medical Center: A Collaborative Medical-Surgical Initiative”, February 27, 2014, Chest, Epub ahead of print.