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Mesothelioma laboratory investigations |
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Mesothelioma laboratory investigations Chest radiographs : Reveals a variable amount of fluid with pleural thickening or pleural nodules, often several centimeters in diameter. Predominance at the base of the lung is almost constant in advanced cases ipsilateral shift of mediastinum and retraction of the involved hemithorax are characteristic, unless the tumor volume becomes very large.
ECG Is abnormal in almost 90% of patients, showing various arrhythmias (sinus tachycardia is the single most common change - 42% cases, but also premature atrial or ventricular contractions, atrial fibrillation, or flutter), conduction abnormalities (right side bundle branch block, left hemiblocks ), non specific ST-T changes or left or right hypetrophy. CT (computer tomography) Is most valuable in showing the extent of disease ( including chest wall, mediastinum, pericardium and diaphragm ), relative amount of fluid and tumor, involvement of interlobar fissures and retraction of involved hemithorax. In addition, signs of asbestos exposure, such as contralateral pulmonary fibrosis and/or pleural plaques, are seen in 50% of cases and pleural calcifications in 15%. MRI Has been better than CT in showing tumors spread into the fissures, diaphragm and mediastinum. ECOcardiography Is useful to reveal pericardial involvement is cardiac tamponade is suspected. Uptake of gallium GA citrate by mesothelioma tumors has been experimentally demonstrated and gallium scan was positive in 43 of 49 patients with pleura mesothelioma. The role of positron emission tomography ( PET ) imaging has been examined in a cohort of 28 patients with suspected mesothelioma ( confirmed in 22 ). The survival distribution of the high - SUV group showed significantly shorter survivals, compared with a low - SUV group. Bronchoscopy is usually normal or reveals extrinsic pressure. Thoracocentesis yields a serous to viscous, glutinous fluid, which is occasionally frankly bloody. The fluid is an exudate, and pleural fluid glucose can be low, but this finding is nonspecific. The best positive marker for malignant mesothelioma is the detection of a high level of hyaluronic acid in the fluid, but this technique is not yet routinely available. Cytological studies in large series revealed malignant cells in 16-38% patients, but there exact nature is often undeterminated and they are diagnostic in 3-16% of patients with mesothelioma. Pleural - needle biopsy shows malignant disease in 13-48% of cases and a diagnosis of mesothelioma in 10-36%. Thoracotomy with open surgical biopsy remains the best diagnostic procedure, yielding the diagnosis in 77%-100% of the patients. Thoracoscopy is a useful technique in cases when is technically possible, yielding a iagnosis of mesothelioma in 70-80% of cases and false-negative results in up to 20% of cases. There is a lack of positive serum markers currently available for the diagnosis of mesothelioma. Serum CEA and AFP values are usually in normal limits. The detection of an elevated serum level of hyaluronic acid may prove useful in differentiating mesothelioma from other tumors, or to follow the effect of the treatment. Sponsor:
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