Measuring the diffusion capacity of the lung preoperatively is important because most patients have poor pulmonary mesothelioma reserve secondary to interstitial lung disease.
A cardiopulmonary stress test with pharmacologic agents is a reasonable choice to eliminate the possibility of evidence of silent myocardial ischemia.
Procedures
See Lab Studies.
Thoracoscopy or pleuroscopy should be performed to confirm the diagnosis.
Laparoscopy is important for staging but is still investigational to evaluate for transdiaphragmatic involvement.
Histologic Findings
See Lab Studies. Gross pathology reveals that the pleural surfaces are seeded with malignant mesothelioma cells, which form grouped nodules. As the disease progresses, it covers the entire pleural space and invades the chest wall, mediastinum, and diaphragm. Microscopically, the 3 histologic types are epithelial, sarcomatous, and mixed. The epithelial type correlates with a better prognosis.13
Staging
Six staging categories have been proposed for mesothelioma. In 1996, Sugarbaker and associates proposed the Brigham staging system based on tumor resectability and nodal status, a system validated in a clinical trial.12 To date, the accepted system is the TNM classification accepted by the International Mesothelioma Interest Group (IMIG).
Stage I - Completely resected within the capsule of the parietal pleura mesothelioma without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites)
Stage II - All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination
Stage III - Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes
Stage IV - Distant metastatic disease
A cardiopulmonary stress test with pharmacologic agents is a reasonable choice to eliminate the possibility of evidence of silent myocardial ischemia.
Procedures
See Lab Studies.
Thoracoscopy or pleuroscopy should be performed to confirm the diagnosis.
Laparoscopy is important for staging but is still investigational to evaluate for transdiaphragmatic involvement.
Histologic Findings
See Lab Studies. Gross pathology reveals that the pleural surfaces are seeded with malignant mesothelioma cells, which form grouped nodules. As the disease progresses, it covers the entire pleural space and invades the chest wall, mediastinum, and diaphragm. Microscopically, the 3 histologic types are epithelial, sarcomatous, and mixed. The epithelial type correlates with a better prognosis.13
Staging
Six staging categories have been proposed for mesothelioma. In 1996, Sugarbaker and associates proposed the Brigham staging system based on tumor resectability and nodal status, a system validated in a clinical trial.12 To date, the accepted system is the TNM classification accepted by the International Mesothelioma Interest Group (IMIG).
Stage I - Completely resected within the capsule of the parietal pleura mesothelioma without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites)
Stage II - All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination
Stage III - Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes
Stage IV - Distant metastatic disease
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