{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:19:11Z","timestamp":1779909551165,"version":"3.53.1"},"reference-count":42,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>To investigate the incidence and risk factors of chest wall metastasis (CWM) at biopsy sites in patients with malignant pleural mesothelioma (MPM). This retrospective cohort study was conducted in 262 consecutive MPM patients who underwent multimodal treatment in which including neoadjuvant chemotherapy (NAC) and curative-intent surgery, from August 2009 to March 2021. CWM was evaluated radiologically (r-CWM) and pathologically (p-CWM). We also investigated the risk factors of p-CWM and the consistency between r-CWM and p-CWM. Of 262 patients, 25 patients were excluded from analysis due to missing data or impossibility of evaluation. Of the eligible 237 patients, pleural biopsy was performed via video-assisted thoracoscopic surgery in 197 (83.1%) and medical thoracoscopy in 40 (16.9%). Pleurodesis was performed after pleural biopsy in 74 patients (31.2%). All patients received NAC followed by curative-intent surgery. Radiological examination showed r-CWM in 43 patients (18.1%), while pathological examination showed p-CWM in 135 patients (57.0%). The incidence of p-CWM was significantly higher in the patients who received pleurodesis after pleural biopsy (77.0% vs. 47.9%, &lt;0.001). Multivariate logistic regression analysis for p-CWM revealed that pleurodesis is an independent risk factor of p-CWM (adjusted hazard ratio, 3.46; 95% confidence interval, 1.84\u20136.52, &lt;0.001). CWM at the biopsy site was pathologically proven in more than half of the patients (57.0%) who received NAC followed by curative-intent surgery, which was higher than the numbers diagnosed by radiological examinations (p-CWM: 57.0% vs. r-CWM: 18.1%). Pleurodesis after pleural biopsy is an independent risk factor of p-CWM.<\/jats:p>","DOI":"10.3390\/cancers14184356","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T20:52:03Z","timestamp":1662583923000},"page":"4356","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Incidence and Risk Factors of Chest Wall Metastasis at Biopsy Sites in Patients with Malignant Pleural Mesothelioma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3247-6025","authenticated-orcid":false,"given":"Masaki","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiko","family":"Yuki","sequence":"additional","affiliation":[{"name":"Department of Molecular Pathology, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9553-996X","authenticated-orcid":false,"given":"Kazuhiro","family":"Kitajima","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Nakamichi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akifumi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7404-2639","authenticated-orcid":false,"given":"Ayuko","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Molecular Pathology, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Yamakado","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohru","family":"Tsujimura","sequence":"additional","affiliation":[{"name":"Department of Molecular Pathology, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiki","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya 6638501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"ref_1","first-page":"S238","article-title":"Management of malignant pleural mesothelioma\u2014The European experience","volume":"6","author":"Opitz","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s00595-015-1275-3","article-title":"Current surgical strategies for malignant pleural mesothelioma","volume":"46","author":"Takuwa","year":"2016","journal-title":"Surg. Today"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Miyoshi, S., Sasada, S., Izumo, T., Matsumoto, Y., and Tsuchida, T. (2016). Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167186"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1136\/thx.2007.092940","article-title":"Pleurodesis for malignant pleural effusion: Talc, toxicity and what next?","volume":"63","author":"Davies","year":"2008","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1053\/j.semtcvs.2009.06.011","article-title":"Current trends in radiologic management of malignant pleural mesothelioma","volume":"21","author":"Gill","year":"2009","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1007\/s11748-020-01295-5","article-title":"Clinical feature of diagnostic challenging cases for pleural biopsy in patient with malignant pleural mesothelioma","volume":"68","author":"Hashimoto","year":"2020","journal-title":"Gen Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1900953","DOI":"10.1093\/ejcts\/ezaa158","article-title":"ERS\/ESTS\/EACTS\/ESTRO guidelines for the management of malignant pleural mesothelioma","volume":"58","author":"Opitz","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5858\/arpa.2017-0124-RA","article-title":"Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement from the International Mesothelioma Interest Group","volume":"142","author":"Husain","year":"2018","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/ejcts\/ezs648","article-title":"Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma","volume":"44","author":"Eberlein","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1002\/cncr.24886","article-title":"Proposed adjustments to pathologic staging of epithelial malignant pleural mesothelioma based on analysis of 354 cases","volume":"116","author":"Richards","year":"2010","journal-title":"Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1200\/JCO.18.01678","article-title":"Prophylactic Irradiation of Tracts in Patients with Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial","volume":"37","author":"Bayman","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_12","first-page":"754","article-title":"Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma","volume":"108","author":"Boutin","year":"1995","journal-title":"A randomized trial of local radiotherapy. Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1093\/ejcts\/ezy258","article-title":"ERS\/EACTS statement on the management of malignant pleural effusions","volume":"55","author":"Bibby","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1053\/j.semtcvs.2019.01.010","article-title":"Surgical Risk and Survival Associated With Less Invasive Surgery for Malignant Pleural Mesothelioma","volume":"31","author":"Hasegawa","year":"2019","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jtcvs.2018.09.106","article-title":"Pleural thickness after neoadjuvant chemotherapy is a prognostic factor in malignant pleural mesothelioma","volume":"157","author":"Hashimoto","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"44","DOI":"10.21037\/shc.2018.05.06","article-title":"Surgical technique of pleurectomy\/decortication","volume":"2","author":"Hashimoto","year":"2018","journal-title":"Shanghai Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1016\/j.jtho.2018.04.034","article-title":"Revised Modified Response Evaluation Criteria in Solid Tumors for Assessment of Response in Malignant Pleural Mesothelioma (Version 1.1)","volume":"13","author":"Armato","year":"2018","journal-title":"J. Thorac. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1016\/j.jtho.2016.08.147","article-title":"Staging and Prognostic Factors Committee, Advisory Boards and Participating Institutions. The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma","volume":"11","author":"Nowak","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1016\/j.jtho.2016.09.121","article-title":"Mesothelioma Domain of the IASLC Staging and Prognostic Factors Committee, advisory boards and participating institutions. The IASLC Mesothelioma Staging Project: Proposals for Revisions of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma","volume":"11","author":"Rice","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/j.jtho.2016.09.124","article-title":"IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions. The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma","volume":"11","author":"Rusch","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11748-013-0345-y","article-title":"FDG PET\/CT is useful for detecting infiltration to the port site in patients with malignant pleural mesothelioma","volume":"62","author":"Kawaguchi","year":"2014","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1136\/thx.2007.081430","article-title":"Population based epidemiology and prognosis of mesothelioma in Leeds, UK","volume":"63","author":"Chapman","year":"2008","journal-title":"Thorax"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1510\/icvts.2010.256214","article-title":"Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma","volume":"12","author":"Chen","year":"2011","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.lungcan.2007.12.022","article-title":"Local recurrence of tumor at sites of intervention in malignant pleural mesothelioma","volume":"61","author":"Metintas","year":"2008","journal-title":"Lung Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1148\/radiol.2412051020","article-title":"Pleural mesothelioma: Sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy","volume":"241","author":"Agarwal","year":"2006","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/j.athoracsur.2019.11.048","article-title":"Clinical Outcomes With Recurrence After Pleurectomy\/Decortication for Malignant Pleural Mesothelioma","volume":"109","author":"Nakamura","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1093\/ejcts\/ezv398","article-title":"Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma","volume":"49","author":"Kostron","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1038\/modpathol.2015.87","article-title":"Loss of expression of BAP1 is a useful adjunct, which strongly supports the diagnosis of mesothelioma in effusion cytology","volume":"28","author":"Andrici","year":"2015","journal-title":"Mod. Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/cncy.21928","article-title":"A combination of MTAP and BAP1 immunohistochemistry in pleural effusion cytology for the diagnosis of mesothelioma","volume":"126","author":"Kinoshita","year":"2018","journal-title":"Cancer Cytopathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1002\/cncy.22409","article-title":"Fluorescence in situ hybridization detection of chromosome 22 monosomy in pleural effusion cytology for the diagnosis of mesothelioma","volume":"129","author":"Kinoshita","year":"2021","journal-title":"Cancer Cytopathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/cncy.21392","article-title":"Claudin-4 immunohistochemistry is highly effective in distinguishing adenocarcinoma from malignant mesothelioma in effusion cytology","volume":"122","author":"Jo","year":"2014","journal-title":"Cancer Cytopathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/dc.24475","article-title":"HEG1, BAP1, and MTAP are useful in cytologic diagnosis of malignant mesothelioma with effusion","volume":"49","author":"Hiroshima","year":"2021","journal-title":"Diagn. Cytopathol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/dc.23271","article-title":"Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary Statement from the International Mesothelioma Interest Group, Also Endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology","volume":"43","author":"Hjerpe","year":"2015","journal-title":"Diagn. Cytopathol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/1759-7714.12967","article-title":"Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP)","volume":"10","author":"Rojas","year":"2019","journal-title":"Thorac. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1440-1843.2005.00763.x","article-title":"Prolonged survival after talc poudrage for malignant pleural mesothelioma: Case series","volume":"10","author":"Aelony","year":"2005","journal-title":"Respirology"},{"key":"ref_36","first-page":"55","article-title":"The role of interleukin-6 in malignant mesothelioma","volume":"4","author":"Ho","year":"2015","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1002\/path.824","article-title":"Vascular endothelial growth factor is an autocrine growth factor in human malignant mesothelioma","volume":"193","author":"Strizzi","year":"2001","journal-title":"J. Pathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3373","DOI":"10.4161\/cc.21397","article-title":"Convergent signaling in the regulation of connective tissue growth factor in malignant mesothelioma: TGF\u03b2 signaling and defects in the Hippo signaling cascade","volume":"11","author":"Fujii","year":"2012","journal-title":"Cell Cycle"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s00408-007-9041-y","article-title":"Pleural mesothelial cells mediate inflammatory and profibrotic responses in talc-induced pleurodesis","volume":"185","author":"Acencio","year":"2007","journal-title":"Lung"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e010589","DOI":"10.1136\/bmjopen-2015-010589","article-title":"Protocol for PIT: A phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention","volume":"6","author":"Bayman","year":"2016","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1080\/02841860701754182","article-title":"Prevention of malignant seeding at drain sites after invasive procedures (surgery and\/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma","volume":"47","author":"Gambaro","year":"2008","journal-title":"Acta Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/sj.bjc.6601957","article-title":"A randomised trial of single-dose radiotherapy to prevent procedure tract metastasis by malignant mesothelioma","volume":"91","author":"Bydder","year":"2004","journal-title":"Br. J. Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/18\/4356\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:24:44Z","timestamp":1760142284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/18\/4356"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":42,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["cancers14184356"],"URL":"https:\/\/doi.org\/10.3390\/cancers14184356","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]}}}