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Eur J Cardiothorac Surg 2007;32:403-408. doi:10.1016/j.ejcts.2007.05.027
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura

^a Division of Pulmonary Medicine, University Hospital of Zurich, Switzerland
^b Division of Thoracic Surgery, University Hospital of Zurich, Switzerland
^c Institute of Pathology, University Hospital of Zurich, Switzerland
^d Department of Nuclear Medicine, University Hospital of Zurich, Switzerland

Received 7 March 2007; received in revised form 23 May 2007; accepted 31 May 2007.

^_* Corresponding author. Address: Oxford Centre for Respiratory Medicine, Churchill Hospital, Headington, Oxford OX3 7LJ, United Kingdom. Tel.: +44 1 865 225 227; fax: +44 1 865 225 221. (Email: Malcolm.Kohler{at}orh.nhs.uk).

Objective: Solitary fibrous tumours of the pleura (SFTP) are rare and can histologically be differentiated into benign and malignant forms. The aim of this study is to present new cases, and discuss up-to-date preoperative examinations, the role of video-assisted thoracic surgery and long-term outcome. Methods: Between 1993 and 2006, 27 SFTPs were diagnosed (14 females, mean age ± SD, 62.3 ± 9.6 years) at our institution. Medical records were reviewed, and follow-up was obtained by repeated examinations or contact with general practitioners. Results: SFTPs were associated with symptoms in 63% of all cases. In the six patients in which positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) was performed preoperatively, malignant lesions were all found to be positive. Complete resection was achieved by video-assisted thoracic surgery in 15 and anterolateral thoracotomy in 12 patients. Mean hospital stay was shorter for patients operated by video-assisted thoracic surgery compared to thoracotomy, 4.5 (range 3–6) versus 7.5 (range 4–25) days, respectively (p < 0.01). Histology revealed 17 benign and 10 malignant SFTP. Mean ± SD tumour diameter of malignant SFTPs was larger than in benign forms, 11.9 ± 7.1 versus 6.1 ± 3.5 cm, respectively (p < 0.01). Tumour recurrence was recognised in four patients with malignant SFTPs at a median time interval after surgery of 38 (range 6–122) months, two late deaths occurred resulting from tumour recurrences. Conclusions: SFTPs can be treated minimally invasively by video-assisted thoracic surgery with short hospital stay. Large SFTPs with increased FDG-uptake have a high likelihood for malignancy. Long-term follow-up is mandatory in malignant SFTPs because of late recurrences associated with death.

Key Words: Pleura • Solitary fibrous tumour • Video-assisted thoracoscopic surgery • Positron emission tomography