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Pleural mesothelioma diagnosis

Pleural mesothelioma diagnosis :

Pleural mesothelioma diagnosis usually begin by seeing your GP or by going to a hospital emergency room probably for chest pain, shortness of breath or another symptom.

Firstly your doctor will examine you, arrange for a variety of tests and maybe send you to a specialist, which is usually a respiratory physician.
And your doctor will also take a history of general health and exposure to asbestos fibers.
Malignant pleural mesothelioma symptoms are often simalr to those of other diseases, and mesothelioma cells can look similar to other types of cancer cells.
This can make the diagnosis extremely complicated in several cases.
For this reason Pleural mesothelioma diagnosis is undergo a number of tests that can rule out other diseases, including a variety types of cancer.

It will be diffcult to differentiate between malignant and benign pleural disease and also to differentiate malignant pleural mesothelioma from other malignancies, such as sarcoma, metastatic adenocarcinoma or other metastases to the pleura.

By using CT, thymoma can mimic malignant pleural mesothelioma; however, pleural effusion does not typically occur with thymoma.

Diagnosis is diffcult, because cytologic samples of pleural fluid are often negative.

Calretinin, WT1, D240, and cytokeratin 5/6 are advantageous immunohistochemical markers for diagnosing malignant pleural mesothelioma, because these markers typically are positive in pulmonary adenocarcinoma(Adenocarcinoma of the lung) and negative in mesothelioma (e.g., thyroid transcription factor 1, carcinoembryonic antigen).

Several health professionals will be there involved in working out whether you have malignant pleural mesothelioma.
Each individual’s pathway to diagnosis will be unique.
The first step in the malignant pleural mesothelioma diagnosis is usually to achieve one or more imaging scans (including: x-ray, PET, CT, or MRI) to recognize potential tumors.
If such that tumor is detected, blood tests may be performed to detect certain biomarkers ( refers to a measurable indicator of some biological condition or state).
If these tests point toward the possibility of precence of mesothelioma, the diagnosis will need to be verified through a biopsy sample – usually through a thoracoscopy, thoracentesis, thoracotomy, or mediastinoscopy.

An accurate and detailed history of asbestos exposure, a physical examination, and imaging studies are very important in the malignant pleural mesothelioma diagnosis.

The steps involved in the diagnosis of malignant pleural mesothelioma may include:

The steps involved in the diagnosis of malignant pleural mesothelioma may include:

  • Providing a full and accurate medical history
  • Providing an occupational history (including possible asbestos exposure)
  • A fully physical examination
  • Imaging tests such as:

o Chest X-ray, PET, CT &/or MRI scans

  • Biopsy – a collection of fluid and/or tissue biopsies

When malignant pleural mesothelioma diagnosis is made, the first essential step is accurate history and the identification of at-risk occupations to ascertain previous asbestos exposure and finally followed by a combination of tests:

General tests for the pleural mesothelioma diagnosis :

Blood test:

Blood samples are taken and analysed to examine your overall health. A blood test will not show up MPM, but it can let doctors to know how your liver, blood cells and kidneys are working properly.

Imaging tests:

Imaging tests are used to help establish whether a suspicious area might be cancerous and to learn how far the cancer may have spread.
Tests that used to diagnose malignant pleural mesothelioma include the following:

Chest x-ray:

The most simple and practical diagnostic method for pleural mesothelioma.
You will have a chest x-ray to show pleural thickening, pleural effusion, nodularity, pleural masses, contraction, and mediastinal shift toward the volume loss.
Additional tests will be needed, if abnormal growth or other changes are found to find the cause because these changes may also also be due to other conditions.
Although this test alone cannot confirm a diagnosis due to the lack of specificity.

CT scan:

Most commonly used to help in pleural mesothelioma diagnosis as it can display the surface of the whole pleura, the diaphragm and the status of lymph nodes.
The CT (short for computerised tomography) scan test uses x-ray beams to make a detailed, three-dimensional image of the inside of the body.
This test provides exact information about the thickness and placement of the tumour(s) within the chest.
It can may also show if the MPM has spread to other organs.
The information obtained by the CT scan is used to assist pick out the best way of obtaining tissue for examination by a pathologist.
A CT scan not causing pain & takes approximately10 minutes. when CT scan is performed you should lie flat on a table that slides in and out of a large, round scanner.
CT scan tests are usually done at a radiology service or a hospital.
An iodine contrast dye is usually injected into a vein in your arm before the scan, to make the scan pictures more clear.
Also you will be asked if you have any allergies to iodine.

PET scan:

Used to show how the lungs and associated tissues are working in the body.

MRI scan:

MRI scan not frequently used in order to diagnose malignant pleural mesothelioma but will also provide further information to ascertain if a patient is a candidate for surgery.

Glossary:

CT scan Computerised tomography uses x-rays, to produce cross-sectional pictures of the body including the bones and soft tissues.
PET scan Positron emission tomography (PET) is a scanning technique which produces a picture of the activity of cells, particularly cancer cells in the body. To conduct the scan, a short-lived radioactive substance, is injected.
MRI Magnetic Resonance Imaging (MRI) is most commonly used to see the internal structure and function of the body. MRI provides much greater contrast between the different soft tissues of the body than (CT) does, making it especially useful in cancer imaging; however its use in the chest is limited because of breathing.
Biopsies A biopsy is a medical test involving the removal of cells or tissues for examination under a microscope by a pathologist, to confirm or rule out cancer.

Biopsy:

A biopsy is the main method used for malignant pleural mesothelioma diagnosis.
Pleural tissue sample will be removed for examination under a microscope by a pathologist to define if the tumour is malignant pleural mesothelioma and, if so, the type of mesothelioma cells present, (i.e. sarcomatoid , epithelioid or biphasic).

To get a biopsy sample for malignant pleural mesothelioma diagnosis can be challenging, so the follwoing can all be involved:
a respiratory physician, thoracic surgeon, radiologist, and pathologist.

A pleural biopsy can be obtained by several ways including:

  • A needle to withdraw tissue or fluid. This may be performed by a radiologist using either an ultrasound or CT scan to guide placement of the needle
  • An endoscope, which looks at the chest through a thin, lighted tube, inserted though the mouth.
    Doctors then use a tool to remove tissue samples through the tube to analyse whether they are cancerous
  • Surgery, a thoracoscopy-guided biopsy is most commonly used to diagnose pleural mesothelioma, which uses real-time imaging to identify the exact sampling point with adequate tissue for biopsy.

VATS(Video-assisted thoracoscopic surgery):

VATS (short for Video-assisted thoracoscopic surgery) is a type of keyhole surgery.
You will be given a general anaesthetic, follwoed by small cuts which can be made between ribs and a camera will be inserted into the pleural cavity.
Pleural samples are taken and then the tissue sample is sent to the pathologist for examination under microscope.
After the Video-assisted thoracoscopic surgery you may spend a few days in hospital. Soreness in the front and lower parts of the chest is common because the nerves between the ribs will have been irritated during surgery.

CT-guided core biopsy:

You will have a local anaesthetic and a needle will be passed between your ribs into the thickest part of the diseased pleura.
A CT scan will be used to guide the needle into position.
During CT scan, you have to lie still on a table, either on your back or front, for approximatelly 30 minutes.
Then you need to stay in the radiology suite for two hours to watch for prospect complications that may appear such as bleeding or a collapsed lung.

cytologic samples are often (-ve) even when patients have malignant plueral mesothelioma.

For the management of pleural effusion pleural catheter or Talc pleurodesis may be needed.

Also serum mesothelin–related peptide levels may be estimated, and these levels may correlate with disease status.

For diagnosis osteopontin does not seem to be helpful.

Other ways to diagnose MPM:

Clinical practice guidelines nowadays for mesothelioma state that:
some methods are not a reliable way to diagnose malignant pleural mesothelioma.
These include samples obtaibned by fine needle aspiration or a biopsy without CT image or ultrasound guidance.
In some cases, a fluid sample instead of a tissue sample can be used to make a diagnosis because it is easier to obtain fluid removed while draining the pleural cavity.
However, it is difficult to see cells under the microscope with fluid samples, particularly as abnormal mesothelioma cells can look similar to cells found in other conditions.
However, some of the mesothelioma specialist diagnostic centres have developed a high level of experience in using fluid samples for mesothelioma diagnosis, provided a large volume of fluid is obtained.
Combining results obtained from the fluid samples with information collected from an x-ray and CT scan (that show the tumour present in adjacent tissue) can give us an acceptable level of certainty of the diagnosis in experienced hands.

Further tests:

Sometimes mesothelioma diagnosis is challenging and the pathologist needs to do additional test known as special staining.
This looks for specific molecules in the biopsy sample that may assist to distinguish pleural mesothelioma from other cancers.
After pleural mesothelioma has been diagnosed, further tests can be done to find out if the disease has spread to other parts of the patient body and, if so, by how much and how far.
This process is known as staging. Knowing the stage of the cancer helps doctors plan the best treatment for you.

In patients with pleural effusion, sampling of the fluid for cytologic testing can help to confirm the diagnosis; however, negative cytologic results do not exclude the possibility of mesothelioma.
Histologic assessment is therefore preferred, with samples obtained through a closed pleural biopsy (Abrams needle), a computed tomography (CT) guided biopsy or a thoracoscopic video-assisted thoracic surgery (VATS).
A contrast-enhanced CT scan is also essential for determining the extent of the disease and for accurate clinical staging.
While magnetic resonance imaging (MRI) is not routine, it may be used to obtain additional staging information, particularly for patients with potentially resectable
disease.
In addition, MRI can be used for patients for whom the CT contrast medium is contraindicated.

Pleural mesothelioma diagnosis

misdiagnoses for pleural mesothelioma:

The most common misdiagnoses for pleural mesothelioma include:

  1. Chronic Obstructive Pulmonary Disease (COPD)
  2. Pneumonia
  3. Asthma
  4. Influenza (the flu)
  5. Other chest cancers, such as lung cancer or adenocarcinoma.

 

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