The Accuracy of Video-Assisted Thoracic Surgery Pleural Biopsy in Patients with Suspected Diffuse Pleural Mesothelioma: A Real-Life Study

Sep 30, 2026

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The study investigates diagnostic accuracy of pleural biopsy (PB) performed via thoracoscopy or video-assisted thoracic surgery (VATS) for patients with suspected diffuse pleural mesothelioma (DPM), within a regional epidemiologic context shaped by asbestos exposure in Piedmont, Italy. Patients receiving PB by VATS from 2004 to 2013 were cross-checked against the Registry of Malignant Mesothelioma records to identify misdiagnosed cases. Among 552 patients, DPM was diagnosed in 178 cases with sensitivity 93% and specificity 100%, and 14 false negatives. Survival and the timing to correct diagnosis are reported, with recommendations for iterative biopsy when clinical suspicion persists.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Introduction

Clinical background and diagnostic challenges

Study rationale and diagnostic pathway

Article The Accuracy of Video-Assisted Thoracic Surgery Pleural Biopsy in Patients with Suspected Diffuse Pleural Mesothelioma: A Real-Life Study Ludovica Balsamo 1,2, Enrica Migliore 3, Eleonora Della Beffa 1,2, *, Luisa Delsedime 4, Paolo Olivo Lausi 1,2, Daniela Di Cuonzo 3, Filippo Lococo 5,6, Paraskevas Lyberis 1,2, Dario Mirabelli 7,†, Mauro Giulio Papotti 4,7, Enrico Ruffini 1,2 and Francesco Guerrera 1,2 Academic Editor: Zenon Pogoreli´c Received: 12 July 2025 Revised: 14 December 2025 Accepted: 17 December 2025 Published: 20 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; [ludovicabalsamo96@gmail.com](ludovicabalsamo96@gmail.com) (L.B.); paolo.lausi@unito.it (P.O.L.); [p.lyberis@gmail.com](p.lyberis@gmail.com) (P.L.); enrico.ruffini@unito.it (E.R.); francesco.guerrera@unito.it (F.G.) 2 Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy 3 Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torino, Italy; enrica.migliore@unito.it (E.M.); daniela.dicuonzo@unito.it (D.D.C.) 4 Department of Pathology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; luisa.delsedime@unito.it (L.D.); mauro.papotti@unito.it (M.G.P.) 5 Thoracic Surgery Unit, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; [filippo.lococo@policlinicogemelli.it](filippo.lococo@policlinicogemelli.it) 6 Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy 7 Department of Oncology, University of Torino, 10126 Torino, Italy * Correspondence: [edellabeffa@gmail.com](edellabeffa@gmail.com) † Deceased author. Abstract Background: The heritage of occupational and environmental asbestos exposure in Piedmont, Italy, has resulted in an enduring diffuse pleural mesothelioma (DPM) epidemic. Our study aimed to investigate the accuracy of Pleural biopsy (PB) via thoracoscopy (or video-assisted thoracic surgery—VATS) and analyze the diagnostic path of patients who experienced an initial DPM misdiagnosis. Methods: Patients who underwent PB by VATS for suspected DPM from 2004 to 2013 were analyzed. The Registry of Malignant Mesothelioma (RMM) records were examined to cross-check incident cases and identify misdiagnosed DPM. The sensitivity and specificity of the initial PB assessment versus the final classification of cases by RMM were evaluated. Results: Data from 552 patients were analyzed, and DPM was diagnosed in 178 cases (32%) . Sensitivity and specificity were 93% and 100%, respectively. The number of false-negative PBs was 14 (2%) . Of those, 10 (71%) had an initial diagnosis of chronic pleuritis, 3 (28.5%) were initially classified as mesothelial proliferation, and 1 had reactive mesothelial proliferation. All of them reported a history of asbestos exposure, and the correct diagnosis was reached after a median of 160 days. Oneand four-year survival rates were 52% and 10% in DPM PB-positive cases and 50% and 19% in false-negative cases. Conclusions: When a strong clinical suspicion after a negative PB remains, iterative biopsy attempts should be considered, especially if a history of asbestos exposure is reported. In high-volume centers, the DPM misdiagnosis rate remains low, and future advancements in diagnostic technologies could further increase the accuracy and efficacy of histologic diagnosis. Keywords: malignant pleural mesothelioma; diffuse mesothelioma; diagnosis; thoracoscopy; pleural effusion; asbestos 1. Introduction Malignant pleural mesothelioma (DPM)—or diffuse pleural mesothe

FAQs

What clinical scenario and diagnostic test does the study evaluate?

The study evaluates the accuracy of pleural biopsy (PB) via thoracoscopy/video-assisted thoracic surgery (VATS) in patients with suspected diffuse pleural mesothelioma (DPM). It focuses on how the initial PB assessment compares with final case classification.

How many patients were analyzed, and what were the key accuracy measures?

Data from 552 patients were analyzed, with DPM diagnosed in 178 cases (32%). Sensitivity was 93% and specificity was 100%, with 14 false-negative PBs (2%).

What does the study recommend when suspicion remains after a negative biopsy?

When strong clinical suspicion persists after a negative PB, iterative biopsy attempts should be considered, particularly when there is a reported history of asbestos exposure. The study also notes low misdiagnosis rates in high-volume centers and potential gains from diagnostic technology advances.

Sep 30, 2026

Upload by jayni