bims-mesote 2025-12-14 papers

Issue of 2025–12–14
five papers selected by
Laura Mannarino, Humanitas Research

BMC Pulm Med. 2025 Dec 10. 25(1): 553

The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy.

Takahiro Ueda, Toshiyuki Nakai, Sayaka Tanaka, Hiroaki Nagamine, Atsushi Miyamoto, Misako Nishimura, Yoshiya Matsumoto, Kanako Sato, Kazuhiro Yamada, Tetsuya Watanabe, Kazuhisa Asai, Yuji Matsumoto, Yu Mikami, Tomoya Kawaguchi.

BACKGROUND: Malignant pleural mesothelioma is a rare disease with a poor prognosis; distinguishing it from non-specific pleurisy is essential for determining an appropriate treatment strategy. We aimed to evaluate the diagnostic utility and safety of full-thickness biopsy performed during semi-rigid pleuroscopy under local anaesthesia to differentiate between malignant pleural mesothelioma and non-specific pleurisy.
METHODS: Consecutive patients who attempted full-thickness biopsy using a cryoprobe or an insulated-tip diathermic knife during semi-rigid pleuroscopy between April 2019 and October 2023 were retrospectively enrolled. The diagnostic utility of full-thickness biopsy for distinguishing malignant pleural mesothelioma from non-specific pleurisy was assessed based on diagnostic accuracy, specimen quality, and procedural safety.
RESULTS: Among the 64 patients who underwent full-thickness biopsy, 28 diagnosed with malignant pleural mesothelioma or non-specific pleurisy were included in this study. With the exception of one malignant pleural mesothelioma case diagnosed by surgical biopsy, 13 malignant pleural mesothelioma and 14 non-specific pleurisy cases were histologically diagnosed through full-thickness biopsy, with clinical courses supporting these diagnoses. The median full-thickness biopsy specimen size was 18.8 mm² (range: 0.6-364.2 mm2), and in 25 cases (89.3%), full-thickness pleura was pathologically confirmed. Full-thickness biopsy demonstrated a sensitivity of 92.9%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an overall diagnostic accuracy of 96.4%. No severe complications were reported with the procedures.
CONCLUSION: Full-thickness biopsy during semi-rigid pleuroscopy provides high diagnostic accuracy and safety for differentiating malignant pleural mesothelioma from non-specific pleurisy, while yielding high-quality pleural tissue specimens.

Keywords: Full-thickness biopsy (FTB); Malignant pleural mesothelioma (MPM); Non-specific pleurisy (NSP); Semi-rigid pleuroscopy

DOI: https://doi.org/10.1186/s12890-025-03982-6

Cancers (Basel). 2025 Dec 01. pii: 3863. [Epub ahead of print]17(23):

Circulating Biomarkers and Targeted Therapy in Pleural Mesothelioma.

Christopher R Grant, Lyudmila Bazhenova, Karen M Yun.

Pleural mesothelioma (PM) is a rare and aggressive cancer. Standard of care for unresectable disease consists of chemotherapy, vascular endothelial growth factor inhibition, immunotherapy, or combinations thereof. Despite recent therapeutic advances, validated diagnostic and prognostic biomarkers are lacking, and no targeted therapies have been approved by the U.S. Food and Drug Administration (FDA) to date. Given the growing body of research investigating molecular alterations in PM, this review summarizes emerging diagnostic and prognostic biomarkers, discusses potentially targetable molecular alterations, and examines ongoing trials directed at targeting specific molecular mechanisms in this disease.

Keywords: biomarker; pleural mesothelioma; targeted therapy

DOI: https://doi.org/10.3390/cancers17233863

Lung Cancer Manag. 2025 Dec;14(1): 2424133

Rucaparib in refractory pleural mesothelioma harboring somatic pathogenic BRCA1 and BRCA2 mutation. A report of two cases.

Luigi Cerbone, Benedetta Del Rio, Sara Delfanti, Francesco Boccuzzi, Paola Barbieri, Antonina Maria De Angelis, Stefano Meda, Laura Savi, Luisella Righi, Marika Sculco, Irma Dianzani, Paolo Bironzo, Federica Grosso.

Pleural mesothelioma is a rare disease with few therapeutic options, especially in the first line refractory setting. Targeted agents did not demonstrate a significant clinical benefit in mesothelioma treatment, nevertheless a small group of patients might harbor potentially actionable somatic mutations, as in homologous repair recombination genes. In this paper we report two cases of patients with heavily pretreated pleural mesothelioma that had a relevant clinical benefit with rucaparib treatment based on somatic BRCA 1 and BRCA 2 mutations detected through next generation sequencing.

Keywords: PARP inhibitors; cancer; genetics; mesothelioma; metastasis; novel therapy; oncogene

DOI: https://doi.org/10.1080/17581966.2024.2424133

Ther Adv Med Oncol. 2025 ;17 17588359251397331

Early severe immune-related pneumonitis, hepatitis, and agranulocytosis with radiographic response in sarcomatoid malignant pleural mesothelioma treated with nivolumab and ipilimumab: a case report highlighting dual liver biopsies and rechallenge decision-making.

Tomohiro Oba, Katsuhiro Itogawa, Yoko Machida, Yuji Ono, Yuho Morita, Daisuke Nakatani, Keiichi Akasaka, Akiko Adachi, Hidekazu Matsushima.

Sarcomatoid malignant pleural mesothelioma (MPM) is a rare and aggressive cancer with limited therapeutic options. We describe an exceptionally rare case of sarcomatoid MPM in a man in his 50s who developed three severe immune-related adverse events (irAEs)-Grade 3 pneumonitis, Grade 3 hepatitis, and Grade 4 agranulocytosis-within 55 days of initiating nivolumab plus ipilimumab. Corticosteroid treatment and granulocyte colony-stimulating factor resulted in recovery from these toxicities, while two liver biopsies provided essential diagnostic insights, distinguishing drug-induced liver injury from immune-related hepatitis. Despite receiving only a limited number of immune checkpoint inhibitor doses and discontinuing therapy, the patient exhibited rapid pleural tumor regression and sustained clinical benefit. This case highlights the potential association between severe immune-related side effects and favorable treatment response in MPM, and underscores the importance of pathology-supported diagnosis and shared decision-making in managing complex irAEs.

Keywords: agranulocytosis; case report; hepatitis; immune checkpoint inhibitors; pneumonitis; sarcomatoid malignant pleural mesothelioma

DOI: https://doi.org/10.1177/17588359251397331

Cancers (Basel). 2025 Dec 01. pii: 3866. [Epub ahead of print]17(23):

Pleural Mesothelioma Diagnosis for the Pulmonologist: Steps Along the Way.

Alberto Fantin, Nadia Castaldo, Ernesto Crisafulli, Giulia Sartori, Filippo Patrucco, Horiana B Grosu, Paolo Vailati, Giuseppe Morana, Vincenzo Patruno, Stefano Kette, Avinash Aujayeb, Aleš Rozman.

Background/Objectives: Malignant pleural mesothelioma (MPM) is a rare, aggressive tumor with a poor prognosis and complex diagnostic pathways. Pulmonologists often play a central role in its initial recognition and investigation. This narrative review synthesizes the current evidence on the diagnostic approach to MPM, with emphasis on imaging, tissue sampling, histopathology, and emerging diagnostic innovations relevant to clinical pulmonology. Methods: English-language studies published between January 2005 and June 2025 were identified from PubMed and Scopus. International guidelines and consensus documents were also reviewed to provide an updated overview of diagnostic strategies. Results: Diagnosis of MPM relies on a stepwise integration of clinical, radiological, and pathological information. Thoracic ultrasound, computed tomography, positron emission computed tomography and magnetic resonance imaging complement each other across different stages of the diagnostic pathway. Image-guided pleural biopsy and medical thoracoscopy remain the gold standard for tissue confirmation, supported by immunohistochemistry and molecular testing. The 2021 World Health Organization classification of pleural tumors and the International Association Study of Lung Cancer 9th Edition Tumour-Node-Mestastatis system have refined histologic and staging criteria, thereby improving reproducibility and prognostic accuracy. Emerging tools, including liquid biopsy, novel serum and molecular biomarkers, artificial-intelligence-based radiomics, and breathomics, offer promise for earlier and less invasive diagnosis but require prospective validation. Conclusions: Current advances are redefining MPM diagnosis toward integrated, multidisciplinary, and precision-based models. Future priorities include standardizing diagnostic algorithms, validating minimally invasive biomarkers, and integrating AI and molecular profiling into clinical workflows to enhance patient stratification.

Keywords: biomarkers; biopsy; diagnosis; imaging; mesothelioma; pleura; thoracoscopy

DOI: https://doi.org/10.3390/cancers17233866