Objective

Mesothelioma carries a poor prognosis. Differentiating benign from malignant pleural disease can be challenging, and may require invasive surgery. We aim to evaluate the effects of benign and malignant pleural disease on chest wall motion using a novel chest wall motion analysis technology (Optoelectronic Plethysmography (OEP)), this may constitute a useful tool in the diagnostic pathway.

Methods

OEP was used to measure chest wall motion of 16 patients recruited to this study. The measurements were performed before any pathological diagnosis. Pathological diagnosis was obtained via surgical pleural biopsy. After the pathological diagnosis, the patients were divided into 3 groups. A pleural disease-free (n=4), an empyema group (n= 6) and a mesothelioma group (n=4). A radiological assessment was performed in all patients.

Results

The contribution of the diseased part of the pulmonary ribcage to the overall pulmonary ribcage motion was significantly lower in the mesothelioma group, 19 +/- 17 % compared the control and empyema group 50 +/- 3 % and 44 +/- 7 % (p 0.01 and p 0.01) respectively (figure 1). The radiological diagnosis matched the pathological diagnosis in only 30% of patients. When the diseased side of the chest contributed ≤ 36% of chest wall motion all patients had a pathological diagnosis of mesothelioma.

Conclusion

This is the first data to describe the effect of empyema and malignant mesothelioma on chest wall mechanics, and proved that OEP, is more predictive than conventional radiology, and could be used in clinical practice to diagnose those diseases.