Correlation between computed tomography of the chest and medical thoracoscopic findings in primary pleural tumors

Abstract

Malignant pleural mesothelioma ( MPM) is an aggressive tumor arising from the mesothelial cells lining the pleura. It commonly presents with unilateral pleural effusion with variable degree of pleural thickening and nodularity. MPM usually develops on the parietal pleura, and involvement of the visceral pleura indicates more advanced stage. Treatment of MPM should not be started before correct diagnosis and staging with computed tomography (CT) and thoracoscopy. The aim of this study was to assess the correlation between findings on chest CT and those on thoracoscopy and to evaluate the sensitivity of chest CT to identify malignant pleural lesions. Patients with suspected MPM and indicated for medical thoracoscopy for diagnostic confirmation were enrolled in the present study. Twenty patients with confirmed diagnosis after tissue biopsies with medical thoracoscopy were selected. Comparison and correlation between CT findings and medical thoracoscopic findings were made. Thoracoscopy showed parietal pleural invasion in all patients, whereas noncontrast chest CT showed parietal pleural lesions in 14 patients (70%). Visceral pleural involvement was evident in 13 patients (65%) on thoracoscopy, but chest CT detected only one case (5%) with visceral pleural involvement. Three patients (15%) were found to have fibrous septations on thoracoscopy, compared with only one patient (5%) on chest CT. The sensitivity of noncontrast chest CT in the detection of MPM was 70%. Although the sensitivity of noncontrast chest CT in the detection of MPM is high, thoracoscopy is needed not only to confirm the diagnosis but also to assess the different parts of the pleura and to allow proper staging of the disease. Egypt J Broncho 2014 8:32–37