Clapper, Patti, Schweizer and Mason

Malignant pleural mesothelioma is a type of cancer that causes tumors to grow within the pleural sac, which is the membrane surrounding the lungs and other vital organs within the chest cavity.  This type of mesothelioma is often associated with difficulty breathing caused by swelling of tissue and the buildup of viscous fluid (called pleural effusion) between the inner and outer layers of this pleural sac.  However, a small but significant portion of pleural mesothelioma victims suffer from what’s known as “dry” mesothelioma.

Patients suffering from dry mesothelioma are no better or worse off than those afflicted with “regular” mesothelioma, however, there are several differences in diagnosis and treatment that doctors must take into account.  Dry mesothelioma is characterized by little or no pleural effusion.  This means that the space between the interior and exterior pleural does not contain excessive fluid.  While at first glance this may seem to be a blessing, dry mesothelioma can be more difficult to diagnose and treat.

Because there is very little fluid within the pleural sac, there is also very little space to work within during exploratory and surgical procedures such as biopsy and partial pleurectomy. Therefore it can be very difficult for surgeons to used targeted mesothelioma treatment methods with patients suffering from dry mesothelioma.

However, one recent study published in the medical journal Lung Cancer shows that dry mesothelioma patients can benefit from diagnostic biopsies if doctors use ultrasound machines to visually display what they cannot see with the naked eye.

The ultrasound machines in question use sound waves to actually “map” parts of the body that the eye cannot see.  Similar to prenatal ultrasounds, these devices measure the reflected sounds waves and use computer algorithms to create a digital image of a portion of the interior body cavity.  Doctors can then use this image in real time to guide surgical tools in order to perform diagnostic biopsies on dry mesothelioma tumors and diseased tissues. 

The research performed by Stigt, Boers, and Groen from the Department of Pulmonology in the Netherlands shows that despite the hardships caused by limited workspace in the chest cavities of dry mesothelioma victims, doctors can still effectively sample tissue and get results accurate enough to confirm or deny the presence of mesothelioma cancer cells within tiny tissue samples. 

For the purposes of their report, the researchers drew upon mesothelioma cases involving 56 patients diagnosed between 2007 and 2012.  Of the 56 individuals, 20 were afflicted with what the doctors categorized as dry mesothelioma – with very little or no pleural effusion.  Fourteen of the 20 patients underwent diagnostic biopsies using ultrasound guidance.  The accuracy of the diagnostic testing was assessed at 80%. 

While this “success” rate doesn’t seem all that exciting, it falls in line with more traditional mesothelioma cases and their primary diagnostic testing.  In any case, the information gathered during this initial internal investigation was clearly enough to suggest the presence of disease and warrant the scheduling of more testing. 

The use of ultrasound guidance significantly lowered the risk of post-surgical complication and only 1 of the 14 patients had any sort of incident following their diagnosis. 

Source:   Analysis of "dry" mesothelioma with ultrasound guided biopsies.