Mesothelioma is often difficult to diagnose because its symptoms are similar to those of many other diseases. It often begins with the appearance of breathing difficulties associated with the presence of an effusion, which in some cases may be accompanied by chest pain. The diagnostic approach should provide for the collection of information on possible exposure to asbestos in previous years and then instrumental examinations such as chest radiography and CT scan.
Thoracentesis
If there is liquid in the chest cavity, it is possible to take a sample by introducing a thin needle into the intercostal space: through a cytological examination it is thus determined the possible presence of neoplastic cells. In the event that there is plenty of fluid, this procedure can also be used to remove enough of it to improve the patient’s breathing.
Histological diagnosis
To obtain a certain histological diagnosis of mesothelioma it is necessary to make tissue samples with different methods and depending on the extent of the disease:
Video assisted thoracoscopy (VATS): Under general anesthesia, a micro-camera is introduced through a small incision in the chest to visualize the pleural surface and take tissue samples. In case of pleural effusion, it is possible to completely aspirate the liquid in order to induce the adhesion of the mesothelium (pleurodesis or talcage), thus preventing the formation of new liquid.
Guided TAC Biopsy: In the case of advanced disease or in patients with anesthesiological contraindications, a sample can be obtained for histological examination using the TAC guide, under local anesthesia.
Once the material for the histological diagnosis is obtained, the pathologist ascertains the type of tumor, its extension and its biological aggressiveness.
Staging
Once the diagnosis is made, the doctor determines the extension (staging) of the tumor using the CAT and PET with FDG in order to localize the site and the tumor activity inside the organism and to select the most effective treatment.
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