"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

Abstract

The acquisition of histologic material is obligatory in order to establish the diagnosis of malignant pleural mesothelioma (MPM). In particular, tissue acquisition in cases of "dry" MPM (focal pleural thickening without pleural effusion or mediastinal lymph node involvement) is usually performed via a thoracoscopic pleural biopsy. In contrast, the techniques for performing echoendoscopic (transbronchial or transesophageal) needle aspiration of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report the first case of "dry" MPM successfully diagnosed via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a 73-year-old man presenting with a pleural mass in the right costovertebral recess, adjacent to the carina. The patient underwent radical resection, and a definitive pathological examination confirmed the diagnosis of epithelioid MPM.

The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma

“…In the case of mesothelioma presenting with mediastinal nodules without effusion (as one of the cases we described), a valuable means of obtaining a tissue specimen is EBUS‐TBNA. Until now, there have been scattered reports about the potential diagnostic impact of EBUS‐TBNA in the field of pleural diseases . EBUS‐TBNA is gaining ground in the nodal staging of mesothelioma to carefully select patients for surgical treatment.…”

“…Until now, there have been scattered reports about the potential diagnostic impact of EBUS-TBNA in the field of pleural diseases. [6][7][8][9] EBUS-TBNA is gaining ground in the nodal staging of mesothelioma to carefully select patients for surgical treatment. Zielinski et al recommended EBUS-TBNA as the first-line procedure for nodal staging in patients with mesothelioma who are considered fit for surgery.…”

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence

“…It may also be used in the diagnosis of MPM, particularly in the so-called "dry" presentation of the disease [24,25]. Conversely, patients with extra-pleural and extra-mediastinal node involvement (not reachable either by mediastinoscopy nor EUS/EBUS) were found to have a better prognosis, supporting the importance of mediastinoscopy [26].…”

A Case report on the Diagnosis of a Rare Pleural Tumor With Endobronchial Ultrasound

“… 6 , 7 Only 1 case of endobronchial sampling and diagnosis of a pleural-based mesothelioma is reported in the literature. 8 Although typically transthoracic biopsy would have been the first step in evaluation of our patient's tumor, we elected to start with flexible bronchoscopy for 2 reasons: First, the transthoracic biopsy of pleural sarcomas is known historically to be often difficult with a low yield. Second, and most importantly, we wanted to assess for endobronchial involvement given the size and near total collapse of the lung and evaluate ipsilateral and contralateral lymph nodes for staging purposes.…”