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Disorders of the Pleura |

Mesothelioma Incidence Following a Diagnosis of Nonspecific Pleuritis

Zachary DePew, MD; Joanne Yi, MD; Fabien Maldonado, MD
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Mayo Clinic, Rochester, MN


Chest. 2013;144(4_MeetingAbstracts):514A. doi:10.1378/chest.1696645
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Abstract

SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Non-specific pleuritis (NSP) is a frequent diagnosis after parietal pleural biopsies, but the clinical significance of this diagnosis has not been firmly established. Previous data suggest that approximately 10% of patients with NSP are eventually diagnosed with mesothelioma in geographic areas with high incidence. We herein review our experience with NSP to clarify the incidence of subsequent mesothelioma in patients diagnosed with NSP amongst our low-risk population.

METHODS: Our pathology database was queried for patients with histological evidence of NSP from 01/01/2001 - 12/31/2012 (n=413). Retrospective review of all medical records was completed. Patients with a diagnosis of empyema, tuberculous pleuritis, active systemic vasculitis, and/or active malignancy at the time of the diagnosis were excluded (n=291). The remaining patients were included and their medical records were reviewed with extraction of data including length of clinical follow-up, subsequent pleural pathology results, and suspected clinical diagnosis.

RESULTS: 122 patients were included in our analysis. Median follow-up was 986 days (3 - 4,404). Three patients were subsequently found to have mesothelioma for a total incidence of 2.5%. Median time to diagnosis of mesothelioma was 244 days (64 - 306). Of the 122 patients included in the analysis, 30 patients had a likely etiology for the pleuritis at the time of the biopsy including prior thoracic surgery within 12 months (n=14), active autoimmune or connective tissue disease (n=10), or a clinical diagnosis of parapneumonic effusion (n=6). Exclusion of these patients from the cohort increases the incidence to 3.3% amongst patients with presumed “idiopathic” NSP.

CONCLUSIONS: The incidence of subsequent mesothelioma amongst patients who have been diagnosed with NSP based on pleural biopsy was 2.5% in all comers and 3.3% in those without any apparent cause. All mesothelioma cases were diagnosed within one year from the initial pleural biopsy. Mesothelioma should remain a consideration after a diagnosis of NSP even in areas with low incidence of mesothelioma.

CLINICAL IMPLICATIONS: Patients with NSP should be followed clinically and radiographically for a minimum of one year even in areas with low incidence of mesothelioma.

DISCLOSURE: The following authors have nothing to disclose: Zachary DePew, Joanne Yi, Fabien Maldonado

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