Malignant pleural mesothelioma: role of thoracoscopy

Malignant pleural mesothelioma (MPM) is refractory to the standard therapeutic options since chemotherapy is only partially effective, radiation therapy simply provides palliation against pain, and surgery. even when performed at a relatively early stage, is controversial, Pleuroscopy is an essential procedure for the management of MPM for several reasons: - It has provided insight into the pathogenesis of this disease in showing carcinogenetic asbestos fibers accumulating in black anthracotic zones of the parietal pleura. Further study suggests that these zones could be the equivalent of the milky spots that have been observed in animals. - It allows a clinical approach in the following aspects: i) diagnosis: the sensitivity and specificity of thoracoscopy is higher than any other method. In addition, thoracoscopic biopsy is considerably more cost-effective than surgical biopsy ii) prognosis: thoracoscopy allows for the division of Stage I Butchart mesothelioma into two subgroups, la, which is an early stage with only parietal pleura involvement, and Ib, which is characterized by the invasion of visceral pleura. iii) therapy: in patients with early-stage disease, pleuroscopy allows the placement of an implantable port for local immunotherapy which is a reasonable therapeutic approach.