273 - Early Detection of Mesothelioma in BAP1-TPDS Patients: A Multidisciplinary Approach

Description: Abstract Title: Early Detection of Mesothelioma in BAP1-TPDS Patients: A Multidisciplinary Perioperative Approach

The National Institutes of Health (NIH) Clinical Center is internationally recognized for its research on rare diseases, including mesothelioma. Malignant mesotheliomas are rare, aggressive cancers most often associated with environmental or occupational exposure to asbestos and related fibers In the United States, approximately 2,500 new cases of malignant pleural mesothelioma (MPM) and 500 cases of peritoneal mesothelioma (PM) are diagnosed annually (Shersher & Liptay, 2013; Verma et al., 2018). The majority of patients present with advanced, unresectable disease and are not candidates for cytoreductive surgery (Maggioni et al., 2016; Verma et al., 2018). Median survival is approximately six months with supportive care alone and extends to 12 months with current standard therapies (Maggioni et al., 2016). These poor outcomes underscore the urgent need for early detection, particularly in individuals with germline BAP1 mutations, which significantly elevate the risk for mesothelioma and other malignancies, including uveal melanoma and renal cell carcinoma.

In 2021, the NIH launched a comprehensive surveillance clinical protocol to detect early signs of mesothelioma. This protocol combines dual-energy CT (DECT) imaging, liquid biopsy (cfDNA), and scheduled minimally invasive procedures—including bronchoscopy, bilateral video-assisted thoracoscopic surgery (VATS), diagnostic laparoscopy, and cystoscopy. All procedures are completed within a single operative session, requiring precise coordination among the perioperative team.

Anesthesia manages dual-lumen endotracheal intubation and positioning; surgeons conduct sequential thoracic, abdominal, and urologic assessments; and surgical technologists ensure separation of instrument sets to prevent cross-contamination. Perioperative clinical research nurses and surgical technologists play a pivotal role by maintaining strict sterile technique, managing complex procedural flow, and overseeing the accurate collection and labeling of specimens for both pathology and research. Their attention to infection prevention, specimen integrity, and patient advocacy is critical to the success of this early detection strategy. This multidisciplinary effort highlights how perioperative clinical research nurses, in collaboration with the entire surgical team, contribute meaningfully to advancing clinical research and improving outcomes for high-risk patient populations.