Malignant Pleural Mesothelioma: Accuracy of CT Against Immunohistochemical Test Among the Mexican Population

• Published in: Archives of medical research 2015-02, Vol.46 (2), p.107-111
• Main Authors: Gopar-Nieto, Rodrigo, Aguilar-Madrid, Guadalupe, Sotelo-Martínez, León, Juárez-Pérez, Cuauhtémoc Arturo, Kelly-García, Javier, Argote-Greene, Luis, Ochoa-Vázquez, María Dolores, García-Bazán, Eric Marco, Ramírez-Pérez, Jorge, Haro-García, Luis, Jiménez-Ramírez, Carmina, Cabello-López, Alejandro
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - diagnostic imaging; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Asbestos - adverse effects; Female; Humans; Immunohistochemistry - methods; Incidence; Internal Medicine; Lung - diagnostic imaging; Lung - pathology; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Male; Mediastinum - diagnostic imaging; Mesothelioma; Mesothelioma - diagnosis; Mesothelioma - diagnostic imaging; Mesothelioma, Malignant; Mexico; Middle Aged; Occupational Exposure; Pleural Neoplasms - diagnosis; Pleural Neoplasms - diagnostic imaging; Retrospective Studies; Sensitivity; Sensitivity and Specificity; Specificity; Tomography; Tomography, X-Ray Computed - methods
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/j.arcmed.2015.02.002

Background and Aims Malignant pleural mesothelioma (MPM) is associated with occupational and environmental exposure to asbestos. The incidence is expected to increase as the use of asbestos is not prohibited in many countries, such as in Mexico. We undertook this study to determine sensitivity, specificity, predictive values and likelihood ratios of computed tomography (CT) in a sample from Mexican population with suspected MPM and other pleuropulmonary diseases. Methods CT films of 38 patients suspected of having MPM were analyzed. A single observer was blinded to MPM diagnoses. The frequencies of ten CT findings were identified. A cut-off point of ≥5 CT findings was established to determine high MPM probability. Sensitivity, specificity, predictive values and likelihood ratio of the CT against biopsy using immunohistochemical testing (IHC) for MPM were calculated. Results Of the 38 patients, 31 had MPM and seven had lung adenocarcinoma. The five key findings were mediastinal pleural thickening 96.7% ( n  = 30), nodular pleural thickening 93.3% ( n  = 29), pleural mass 83.9% ( n  = 26), diminished lung 70.9% ( n  = 22) and contracted hemithorax 70.9% ( n  = 22). Sensitivity 96.8% (83.2–99.4), specificity 85.7% (42.2–97.6), positive likelihood ratio 6.7 (1.1–41.6), and negative likelihood ratio of 0.04 (0.01–0.2) were reported. Conclusions Sensitivity and specificity in this study was greater than previously reported, 96.8% and 85.7 vs. 93.2 and 65.6%, respectively. CT is an easily accessible and useful tool that should be incorporated into the medical education of general physicians to improve MPM diagnosis of suspected cases.