Computed tomographic characterization of malignant peritoneal mesothelioma

Our plain-English summary of Computed tomographic characterization of malignant peritoneal mesothelioma, by T.D. Yan, N. Haveric, C.P. Carmignani, et al (Tumori, 2005).

The study

• Authors: T.D. Yan, N. Haveric, C.P. Carmignani, C.M. Bromley, P.H. Sugarbaker
• Journal: Tumori
• Published: 2005;91(5):394-400
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: Peritoneal mesothelioma is a rare disease with a universally fatal outcome when managed in a traditional palliative manner. New approaches to treatment using cytoreductive surgery and intraperitoneal chemotherapy suggest that long-term survival is possible in selected patients. Early recognition of this disease process with an orderly surgical approach will begin to optimize treatment.

Methods: Thirty-three patients with malignant peritoneal mesothelioma had CT scans available for review. A Z-score was used to evaluate the incidence of cancer at a particular anatomic site as compared to a general incidence of disease at all sites. CT was analyzed by abdominopelvic anatomic sites (16), abdominopelvic regions (9), and for presence versus absence of disease in the chest. Interpretative CT findings (class 0-III) were determined for these 33 patients.

Results: Eight of 33 patients had pleural abnormalities. In an analysis of 16 abdominopelvic anatomic sites, the vesical or rectal uterine pouch was involved in 97% and the greater omentum in 91%. These anatomic sites were the only ones with a positive Z-score of >1. In the analysis of 9 abdominopelvic regions, the central and pelvic regions had Z-scores >2 for large volume disease >5 cm. For CT interpretative findings class I, class II and class III was determined in approximately one-third in each category. Sixty-six percent of the patients had ascites by CT.

Conclusions: Malignant peritoneal mesothelioma by CT evaluation predominates in tumor mass within the central and pelvic portions of the abdomen. Minimal, moderate, and extensive small bowel enlargements were seen in roughly one-third of the patients. With the use of the Z-score and interpretative small bowel findings a radiologic characterization of this disease for primary radiologic diagnosis is possible.

In plain English

This study reviewed preoperative CT scans of 33 patients with malignant peritoneal mesothelioma. They came from 71 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy at the Washington Cancer Institute between 1989 and 2003. The scans were reread to record where tumor appeared and how large it was. The article did not report on asbestos exposure. In the chest, 8 of the 33 patients had pleural thickening, always in the basal areas, and 5 had pleural effusion. In the abdomen, the sites most often involved were the rectovesical or rectouterine pouch (97%), the greater omentum (91%) and the right paracolic gutter (88%). Tumor larger than 5 cm was seen in the central region in 70% of patients and in the pelvis in 67%. No patient had disease spread outside the peritoneum to lymph nodes or distant sites. Small bowel involvement was graded class 0 in 3 patients, class I in 9, class II in 9 and class III in 12. Sixty-six percent had ascites. The authors concluded that the disease shows a distinctive pattern that may help radiologic diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of preoperative CT scans in a series of surgically treated patients (imaging case series); scans were reread using a standardized data sheet
• Who was studied: 33 patients with malignant peritoneal mesothelioma who had preoperative abdominal, pelvic and chest CT available. They were drawn from 71 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy at the Washington Cancer Institute, Washington, DC, between 1989 and 2003. Five patients with multicystic peritoneal mesothelioma were excluded. Of the 33, 21 (63%) were male and 12 (36%) female; the mean age at diagnosis was 49.
• Exposure: Not reported. The study examined CT imaging findings; asbestos exposure and fiber types are not discussed.
• Main results:
  • Chest CT, 33 patients: 8 had pleural thickening, in the basal areas in all of them. 5 had pleural effusion, and 4 of these 5 also had pleural thickening. None had pulmonary parenchymal metastases, mediastinal lymph node involvement or pericardial thickening.
  • Across 16 abdominopelvic anatomic sites, the most commonly involved were the rectovesical or rectouterine pouch (97%), greater omentum (91%) and right paracolic gutter (88%).
  • By Z-score, only the rectovesical/rectouterine pouch had a positive score above one (1.1 in Table 3). The pancreatic surface scored -1.94 and the retroperitoneal space -2.6.
  • No patient had intrahepatic or intrasplenic metastasis or extraperitoneal spread to lymph nodes or systemic sites. Three patients had ureteral obstruction by pelvic tumors.
  • Two patients had a large isolated tumor mass: one of 7 cm in the jejunal mesentery and one of 12 cm on the parietal peritoneum in the left lower quadrant.
  • Large volume disease was found in the central region in 70% of patients and in the pelvis in 67%. For tumor greater than 5 cm, both regions had Z-scores greater than 2 (2.2 and 2.04 in Table 4).
  • Small bowel and mesentery CT class, by the worst of 4 small bowel regions: class 0 in 3 patients (9%), class I in 9 (27%), class II in 9 (27%), class III in 12 (36%).
  • Ascites: 66% of patients had ascites. 13 patients (reported as 41%) had marked ascites, and 10 of them (31%) had ascites in both the greater sac and the lesser sac.
• The authors' conclusion: The authors concluded that the CT data support a diffuse spread of malignant peritoneal mesothelioma, with large volume disease in the mid-abdomen and pelvis. In their view, this distinctive pattern of progression on peritoneal surfaces may help in making a radiologic diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Palliative Care, Cytoreductive Surgery, Chemotherapy, CT Scan, Omentum, Ascites.

Related studies

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• Concerning CT features predict outcome of treatment in patients with malignant peritoneal mesothelioma — P.H. Sugarbaker, D. Chang, et al. (2021)
• Computed tomographic assessment of patients following radical surgery for malignant mesothelioma — H. Adams, E.G. Butchart (1992)
• Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis — J.D. Rivard, W.J. Temple, et al. (2014)
• Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up — P.J. Guest, R.H. Reznek, et al. (1992)
• Ultrasonography and computed tomography of peritoneal mesothelioma — H.C. Yeh, A.P. Chahinian (1980)

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