Mesothelioma is a rare, and aggressive cancer affecting mainly the lungs, the area around the heart and abdomen, depending upon the subtype.

A major cause of mesothelioma is excessive inhalation of devastating asbestos fibers. Patients suffering from mesothelioma firstly receive chemotherapy. Depending upon the age, overall health, and the metastatic condition of cancer, surgeons may recommend going for surgical options to eradicate the malignant mesothelioma.

Importance of Staging To Perform Surgery on Malignant Mesothelioma Patients

Cytoreductive surgery is the most commonly done surgery on the pleural mesothelioma patients. And as per a recently published research, pairing the HIPEC- Hyperthermic intraperitoneal chemotherapy with Cytoreductive surgery has proven to be tremendously helpful in improving the survival time of mesothelioma patients.

But surgeons deciding whether a patient can undergo surgery or not is crucially important, as along with highlighting benefits attached to the increased survival time, there is also a high risk of mortality and morbidity attached to the surgical procedures.

Depending upon the type of surgery performed on the patient, the surgeon may have entirely removed the lung affected by cancer, or partially removed the areas of the lung affected by cancer. Detection of cancer cells in the lymph nodes is the crucial factor in analyzing the need for surgery for the patient's health and survival. As the researchers said in the report that,

(Lymph) Nodal metastasis is a negative prognostic factor in MPM, associated with reduced survival.

Previous research has shown that before treating the malignant pleural mesothelioma with a combination of comprehensive surgical treatments such as EPP (extrapleural pneumonectomy), IMRT (hemithoracic intensity-modulated radiation therapy), and P/D radical pleurectomy/decortication, having the nodal status of the patient can be extremely helpful.

This Canadian research has mainly shed light on the much precise, minimally invasive, and comparatively speedy procedure to check the presence of pleural mesothelioma.

Surgeons can use this ultrasound-guided biopsy procedure to examine the malignant mesothelioma staging with the utmost precision, and least possible invasion. This needle procedure can help both surgeons and patients to devise the best treatment plan according to the cancer stage and the patient's health.

In this method, ain the mediastinum. The mediastinum is the central part of the thoracic cavity that contains all the vital organs and tissues of the chest other than the lungs. This region encloses thymus glands, heart, parts of the esophagus, trachea, lymph nodes of the chest, and other vital structures.

Canadian researchers published a study in the Journal of Thoracic Disease in February 2019, elaborating the benefits of incredibly precise predictive technique Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

EBUS-TBNA is an ultrasound-guided method that is used to perform lung biopsy using a needle and is an exceptional alternative to costly, hazardous, and risky procedures performed to examine the central thoracic region (mediastinum).

In the advanced stages of malignant pleural mesothelioma, the cancerous cells invade the lymph nodes present in the cavity of the mediastinum. The detection of the presence of metastasis in the lymph nodes informs about the need for surgery for the patient.

Highlighting the importance of accurate staging technique, the Canadian researchers gave write in the report,

Accurate preoperative staging is key to direct management of patients with MPM, to improve survival while avoiding mortality and morbidity associated with multimodality treatments.

This particular method involving needle insertion can replace the tricky, supremely invasive and time taking methods of pleural mesothelioma staging instance of cancerous cells in the lymph nodes.

Mesothelioma Staging Through Ultrasound Guidance

In EBUS-TBNA- endobronchial ultrasound-guided transbronchial needle aspiration, surgeons check the presence of cancerous cells through ultrasound operated needle in the space present between the spinal column and sternum. There, the needle will remove some cells of the lymph nodes to test and predict the stage of mesothelioma. This method of resting and detection can replace the bigger, costly, and riskier procedures of cancer staging.

Help in Deciding for the Surgical Procedure for Malignant Mesothelioma

The authenticity of this method EBUS-TBNA- endobronchial ultrasound-guided transbronchial needle aspiration was checked by examining 48 patients who had undergone surgery for the removal of malignant mesothelioma. The average age of these patients diagnosed with mesothelioma was 70 years (ranging from 48 to 84 years) between 2012 and 2014. Of these patients, doctors diagnosed more than 70% (34/48) of them with epithelioid mesothelioma and diagnosed more than 8% with biphasic mesothelioma.

The specificity value or accuracy of EBUS-TBNA was 100%, excluding the patients with no adverse effect of asbestos fibers accurately. But the diagnostic accuracy for informing which patients have mesothelioma was 70.6%. Similarly, the negative predictive value of this procedure was also less than 70%.

EBUS-TBNA proved to be exceptionally helpful in determining which patient must not undergo surgery, as the lead author has reported,

“EBUS-TBNA mediastinal lymph node staging prevented unnecessary surgery in 18.8% (9/48 patients) by detection of N2/N3 disease (8 patients) and metastatic secondary malignancy (1 patient),”

Additionally, in comparison with other staging procedures,

"There were no EBUS-TBNA related complications."

Along with several benefits of this procedure, the Researchers have examined a few limitations as well. One such restriction is the occurrence of nodal metastasis between the time doctors test the patient for cancer staging and the time the surgeon performs surgery.

Addressing this issue, the authors have written that,

"The time interval between the staging procedures and the surgery might have allowed for disease progression leading to discordance between the EBUS-TBNA and the surgical pathology results, lowering EBUS-TBNA performance characteristics."

This research has further highlighted, compared, and proved the positive results of EBUS-TBNA- endobronchial ultrasound-guided transbronchial needle aspiration method of lung biopsy, and through further research and clinical examinations, this cancer staging procedure may replace the currently in use procedures by the surgeons. Thus, prevent the patients from going through unnecessary and non-beneficial surgeries to treat malignant mesothelioma. Moreover, by avoiding the surgical procedures, this method may help in declining the surgery-related complications and also deaths.

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