Diagnosis of Mesothelioma Using Flexible Bronchoscopy With Endobronchial Ultrasound-guided Biopsy of Mediastinal Lymph Nodes.

Malignant mesothelioma is a neoplasm that can arise from the mesothelial surface of the pleura and tends to be locally invasive. Various techniques have been used for diagnosis and include thoracentesis with pleural fluid cytology, closed pleural biopsy, and video-assisted thoracoscopic surgery. Thoracentesis and closed pleural biopsy can often establish the presence of malignancy, but frequently do not provide sufficient tissue to definitively diagnose malignant mesothelioma. Video-assisted thoracoscopic surgery biopsy has higher sensitivity for establishing the diagnosis, but is a more invasive procedure and is usually performed under general anesthesia. We discuss 2 cases in which the diagnosis of malignant pleural mesothelioma was made through flexible fiberoptic bronchoscopy with endobronchial ultrasound-guided mediastinal lymph node biopsy. We suggest that this technique provides a relatively noninvasive means for earlier definitive diagnosis of malignant mesothelioma when chest imaging demonstrates mediastinal lymphadenopathy.