Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG).
Malignant pleural mesothelioma is a rare malignant disease that in the majority of cases is associated with asbestos exposure. The incidence in Europe is about 20 per million inhabitants and it is increasing worldwide. Initial symptoms are shortness of breath, pleural effusion, cough, and chest pain. The typical growth pattern is along the pleural surface; however, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage. Ultimately, distant metastases outside the chest can result. Several histological subtypes of pleural mesothelioma exist, which must be differentiated from either benign diseases or metastases in the pleural space by other tumor entities. This differential diagnosis can be very difficult and a large panel of immunohistochemical markers is required to establish the exact diagnosis. The standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis is videothoracoscopy. Full thickness biopsies are required, while transthoracic needle puncture of pleural fluid or tissue is considered to be insufficient for a cytological diagnosis. Complete and detailed staging is mandatory for categorization of the disease as well as for therapeutic decision making.
Department of Pulmonology, Klinikum Klagenfurt, Feschnigstraße 11, Klagenfurt, Austria. christian@geltner.at.|Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. christian@geltner.at.
Christian
C
Geltner
Department of Pulmonology, University Clinic Krems, Krems, Austria.
Peter
P
Errhalt
Department of Pulmonology, Landeskrankenhaus Vöklabruck, Vöklabruck, Austria.
Bernhard
B
Baumgartner
Department of Pulmonology, Landeskrankenhaus Graz Südwest, Graz, Austria.
Gerhard
G
Ambrosch
Rehabilitation Center Tobelbad, Allgemeine Unfallversicherungsanstalt, Tobelbad, Austria.
Barbara
B
Machan
Department of Pulmonology, Landeskrankenhaus Wels, Wels, Austria.
Josef
J
Eckmayr
Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Thomas
T
Klikovits
Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Mir Alireza
MA
Hoda
Department of Pathology, Medical University Graz, Graz, Austria.
Helmut
H
Popper
Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Walter
W
Klepetko
D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008654:Mesothelioma / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors
Diagnosis; Epidemiology; Malignant pleural mesothelioma; Pathology; Staging