Endobronchial ultrasound in the diagnosis of malignant pleural mesothelioma

• Published in: Revue des maladies respiratoires Vol. 32; no. 7; p. 750
• Main Authors: Guinde, J, Laroumagne, S, Kaspi, E, Martinez, S, Tazi-Mezalek, R, Astoul, P, Dutau, H
• Format: Journal Article
• Language: French
• Published: France 01-09-2015
• Subjects: Aged; Biopsy, Fine-Needle - methods; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Mesothelioma - diagnostic imaging; Mesothelioma - pathology; Mesothelioma, Malignant; Pleural Neoplasms - diagnostic imaging; Pleural Neoplasms - pathology; Radiography, Thoracic; Thoracoscopy - methods; Ultrasonography, Interventional; Bronchoscopy; Échoendoscopie; Endobronchial ultrasound bronchoscopy; Mésothéliome pleural; Pleural mesothelioma; Bronchoscopie; Plèvre; Pleura
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2014.12.009

The diagnosis of malignant pleural mesothelioma relies mostly on the pathological examination of pleural samples, validated by a panel of experts and generally obtained during medical or surgical thoracoscopy performed for the management of an exudative pleural effusion. In the absence of pleural effusion (dry-type mesothelioma), the diagnostic approach depends on the features of the lesions (pleural thickness, nodules and/or masses) and their pleural location. Ultrasound and CT-guided needle aspiration represent recognized alternative diagnostic techniques in these situations. We present the case of a patient, presenting a dry-type mesothelioma, whose diagnosis was obtained by endobronchial ultrasound (EBUS)-guided needle aspiration of a pleural mediastinal mass and confirmed by a CT-guided needle aspiration of another pleural mass in close contact with the chest wall. The samples have been compared and show quantitative and qualitative similarities. EBUS represents a minimally invasive alternative diagnostic technique for dry-type mesothelioma, showing thickness of the mediastinal pleura in contact with a central airway or when thoracoscopy, which remains the "gold standard" diagnostic approach, is not feasible.