{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:33:48Z","timestamp":1791506028606,"version":"4.3.4"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The heritage of occupational and environmental asbestos exposure in Piedmont, Italy, has resulted in an enduring diffuse pleural mesothelioma (DPM) epidemic. Our study aimed to investigate the accuracy of Pleural biopsy (PB) via thoracoscopy (or video-assisted thoracic surgery\u2014VATS) and analyze the diagnostic path of patients who experienced an initial DPM misdiagnosis. Methods: Patients who underwent PB by VATS for suspected DPM from 2004 to 2013 were analyzed. The Registry of Malignant Mesothelioma (RMM) records were examined to cross-check incident cases and identify misdiagnosed DPM. The sensitivity and specificity of the initial PB assessment versus the final classification of cases by RMM were evaluated. Results: Data from 552 patients were analyzed, and DPM was diagnosed in 178 cases (32%). Sensitivity and specificity were 93% and 100%, respectively. The number of false-negative PBs was 14 (2%). Of those, 10 (71%) had an initial diagnosis of chronic pleuritis, 3 (28.5%) were initially classified as mesothelial proliferation, and 1 had reactive mesothelial proliferation. All of them reported a history of asbestos exposure, and the correct diagnosis was reached after a median of 160 days. One- and four-year survival rates were 52% and 10% in DPM PB-positive cases and 50% and 19% in false-negative cases. Conclusions: When a strong clinical suspicion after a negative PB remains, iterative biopsy attempts should be considered, especially if a history of asbestos exposure is reported. In high-volume centers, the DPM misdiagnosis rate remains low, and future advancements in diagnostic technologies could further increase the accuracy and efficacy of histologic diagnosis.<\/jats:p>","DOI":"10.3390\/jcm15010042","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T11:30:18Z","timestamp":1766489418000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Accuracy of Video-Assisted Thoracic Surgery Pleural Biopsy in Patients with Suspected Diffuse Pleural Mesothelioma: A Real-Life Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3927-4746","authenticated-orcid":false,"given":"Ludovica","family":"Balsamo","sequence":"first","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Migliore","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8710-7190","authenticated-orcid":false,"given":"Eleonora","family":"Della Beffa","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Delsedime","sequence":"additional","affiliation":[{"name":"Department of Pathology, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Olivo","family":"Lausi","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Di Cuonzo","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8022-0083","authenticated-orcid":false,"given":"Paraskevas","family":"Lyberis","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Mirabelli","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2713-1700","authenticated-orcid":false,"given":"Mauro Giulio","family":"Papotti","sequence":"additional","affiliation":[{"name":"Department of Pathology, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Oncology, University of Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ruffini","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4125-4379","authenticated-orcid":false,"given":"Francesco","family":"Guerrera","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"},{"name":"Department of Surgical Science, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"ref_1","unstructured":"Jain, S.V., and Wallen, J.M. (2022). Malignant Mesothelioma. StatPearls [Internet], StatPearls Publishing. [Updated 2022 Jul 4]."},{"key":"ref_2","first-page":"127","article-title":"Clinical staging of malignant pleural mesothelioma: Current perspectives","volume":"8","author":"Bonomi","year":"2017","journal-title":"Lung Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MCP.0000000000000489","article-title":"Updates in the diagnosis and treatment of malignant pleural mesothelioma","volume":"24","author":"Katzman","year":"2018","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jain, M., Crites, M.K., Rich, P., and Bajantri, B. (2024). Malignant Pleural Mesothelioma: A Comprehensive Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195837"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.rmed.2012.04.009","article-title":"Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy","volume":"106","author":"Metintas","year":"2012","journal-title":"Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1016\/j.athoracsur.2014.01.057","article-title":"Nonspecific pleuritis: Optimal duration of follow-up","volume":"97","author":"DePew","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.2174\/2211536605666160128151018","article-title":"Prognostic and Therapeutic Implications of MicroRNA in Malignant Pleural Mesothelioma","volume":"5","author":"Truini","year":"2016","journal-title":"Microrna"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.21037\/tlcr.2019.11.29","article-title":"Application of immunohistochemistry in diagnosis and management of malignant mesothelioma","volume":"9","author":"Chapel","year":"2020","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zhu, M., Lu, Z., Guo, H., Gu, X., Wei, D., and Zhang, Z. (2023). Diagnostic value of combination of biomarkers for malignant pleural mesothelioma: A systematic review and meta-analysis. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1136049"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E96","DOI":"10.1111\/j.1365-2559.2012.04196.x","article-title":"The diagnostic value of immunohistochemically detected methylthioadenosine phosphorylase deficiency in malignant pleural mesotheliomas","volume":"60","author":"Zimling","year":"2012","journal-title":"Histopathology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.medcli.2022.03.007","article-title":"Pleural mesothelioma","volume":"159","author":"Porcel","year":"2022","journal-title":"Med. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"v31","DOI":"10.1093\/annonc\/mdv199","article-title":"Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Baas","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"176","DOI":"10.5603\/RPOR.a2022.0008","article-title":"Intraoperative near-infrared molecular imaging for diagnostic thoracoscopy in difficult clinical scenarios","volume":"27","author":"Guerrera","year":"2022","journal-title":"Rep. Pract. Oncol. Radiother."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Iaffaldano, A., Charrier, T., Lococo, F., Damotte, D., Bobbio, A., Alifano, M., and Fournel, L. (2021). Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years\u2019 Experience at a High-Volume Referral Center. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091973"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1111\/crj.12940","article-title":"What is the significance of non-specific pleuritis? A trick question","volume":"12","author":"Janssen","year":"2018","journal-title":"Clin. Respir. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1007\/s00018-014-1584-5","article-title":"Role of microRNAs in malignant mesothelioma","volume":"71","author":"Truini","year":"2014","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_17","first-page":"271","article-title":"Differentiation of serosal hyperplasia and neoplasia in biopsies","volume":"1","author":"McCaughey","year":"1986","journal-title":"Pathol. Annu."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Moro, J., Sobrero, S., Cartia, C.F., Ceraolo, S., Rapan\u00e0, R., Vaisitti, F., Ganio, S., Mellone, F., Rudella, S., and Scopis, F. (2022). Diagnostic and Therapeutic Challenges of Malignant Pleural Mesothelioma. Diagnostics, 12.","DOI":"10.3390\/diagnostics12123009"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/MCP.0b013e3283470293","article-title":"Outcome of patients with non-specific pleuritis at thoracoscopy","volume":"17","author":"Wrightson","year":"2011","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Daverio, M., Tin\u00e8, M., Semenzato, U., Prevedello, R., Dalla Libera, M., Cocconcelli, E., Balestro, E., Damin, M., Spagnolo, P., and Biondini, D. (2025). Non-Specific Pleuritis After Medical Thoracoscopy: The Portrait of an Open Issue and Practical Hints for Its Management. Biomedicines, 13.","DOI":"10.3390\/biomedicines13081934"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zupanc, C., Franko, A., \u0160trbac, D., Kova\u010d, V., Dol\u017ean, V., and Gori\u010dar, K. (2023). Serum Calretinin and Genetic Variability as a Prognostic and Predictive Factor in Malignant Mesothelioma. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25010190"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"118357","DOI":"10.1016\/j.ecoenv.2025.118357","article-title":"A four-miRNA signature as a potential biomarker of malignant mesothelioma patients from hand-spinning asbestos exposed area in Eastern China","volume":"299","author":"Zhu","year":"2025","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102547","DOI":"10.1016\/j.tranon.2025.102547","article-title":"The role of non-coding RNAs in pleural mesothelioma","volume":"62","author":"Tonnini","year":"2025","journal-title":"Transl. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1038\/s41417-025-00885-w","article-title":"Therapeutic potential of synthetic microRNA mimics based on the miR-15\/107 consensus sequence","volume":"32","author":"Reid","year":"2025","journal-title":"Cancer Gene Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13046-025-03283-0","article-title":"miRNA-503 inhibition exerts anticancer effects and reduces tumor growth in mesothelioma","volume":"44","author":"Piccioni","year":"2025","journal-title":"J. Exp. Clin. Cancer Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2416792","DOI":"10.1016\/j.pulmoe.2024.02.002","article-title":"The role of MicroRNAs as early biomarkers of asbestos-related lung cancer: A systematic review and meta-analysis","volume":"31","author":"Mukhopadhyay","year":"2025","journal-title":"Pulmonology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/07482337251342903","article-title":"Studies on the regulatory role of microRNA-30d in chrysotile-transformed MeT-5A cells","volume":"41","author":"Li","year":"2025","journal-title":"Toxicol. Ind. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102520","DOI":"10.1016\/j.tranon.2025.102520","article-title":"MiR-193b-3p and miR-132-3p as prognostic biomarkers of survival in pleural mesothelioma patients treated with first-line bevacizumab plus pemetrexed-platinum chemotherapy in the IFCT-0701 MAPS phase 3 trial","volume":"61","author":"Levallet","year":"2025","journal-title":"Transl. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sorino, C., Mondoni, M., Marchetti, G., Agati, S., Inchingolo, R., Mei, F., Flamini, S., Lococo, F., and Feller-Kopman, D. (2023). Pleural Mesothelioma: Advances in Blood and Pleural Biomarkers. J. Clin. Med., 12.","DOI":"10.3390\/jcm12227006"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4968","DOI":"10.3390\/curroncol31090368","article-title":"Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time?","volume":"31","author":"Roca","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4097","DOI":"10.1038\/s41591-025-03958-3","article-title":"Perioperative nivolumab or nivolumab plus ipilimumab in resectable diffuse pleural mesothelioma: A phase 2 trial and ctDNA analyses","volume":"31","author":"Reuss","year":"2025","journal-title":"Nat. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/42\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T11:52:57Z","timestamp":1766490777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/42"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,20]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010042"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010042","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,20]]}}}