Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases

Our plain-English summary of Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases, by M. Metintas, I. Ucgun, O. Elbek, et al (European Journal of Radiology, 2002).

The study

• Authors: M. Metintas, I. Ucgun, O. Elbek, S. Erginel, S. Metintas, M. Kolsuz, E. Harmanci, F. Alatas, G. Hillerdal, R. Ozkan, T. Kaya
• Journal: European Journal of Radiology
• Published: 2002;41(1):1-9
• Cited by: 107 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases.

Materials And Methods: We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases.

Results: In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy.

Conclusion: A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.

In plain English

This retrospective study compared chest CT scans of 215 patients with pleural disease included between May 1989 and October 1998. There were 99 with malignant pleural mesothelioma, 39 with cancer that had spread to the pleura from elsewhere (metastatic pleural disease), and 77 with benign disease, including 19 with asbestos-related advanced benign pleural disease. A 'pleural rind' (thickening encircling the lung, including the side facing the middle of the chest) was seen in 70% of mesothelioma cases, 15% of metastatic cases, 9% of tuberculous pleurisy cases and 5% of asbestos-related benign cases. Pleural thickening over 1 cm was seen in 59% of mesothelioma and 17% of metastatic cases. For telling mesothelioma from metastatic disease, the rind had a sensitivity of 70% and a specificity of 85%. Spread into the chest wall, pericardium, diaphragm or mediastinum was seen only in malignant cases. The authors concluded that when one or more of the key features are seen, there is a high probability of malignant pleural disease. They stated that a definite diagnosis still requires examination of tissue samples.

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: Retrospective comparative study of CT scans in malignant and benign pleural diseases
• Who was studied: 215 patients: 99 with malignant pleural mesothelioma (MPM), 39 with metastatic pleural disease (MPD), 32 with tuberculous pleurisy (TP), 26 with empyema and 19 with asbestos-related advanced benign pleural disease (ARBPD). Patients with pleural plaques were excluded.
• Exposure: Not an asbestos exposure study. The study examined CT features of pleural disease. Documented asbestos exposure was a diagnostic criterion only for the ARBPD group. No fiber types, jobs or doses are given.
• Main results:
  • Pleural rind was seen in 70% of MPM cases, 15% of MPD cases, 9% of TP cases and 5% of ARBPD cases. It was not seen in empyema.
  • Pleural thickening greater than 1 cm was seen in 59% of MPM cases and 17% of MPD cases.
  • For differentiating MPM from MPD, sensitivity/specificity values were 70/85 for rind-like pleural involvement, 85/67 for mediastinal pleural involvement, and 59/82 for pleural thickness more than 1 cm.
  • For differentiating malignant (MPM plus MPD) from benign pleural disease, sensitivity/specificity values were 54/95 for rind-like involvement, 70/83 for mediastinal pleural involvement, 38/96 for pleural nodularity and 47/64 for pleural thickness more than 1 cm.
  • Involvement of the mediastinum, chest wall, pericardium and diaphragm was seen only in patients with MPM or MPD.
• The authors' conclusion: The authors concluded that when one or more of these CT findings (pleural rind, mediastinal pleural involvement, pleural nodularity, pleural thickening more than 1 cm) are seen, there is a high probability of malignant pleural disease.
• Limitations the authors state:
  • The authors state that a definite diagnosis of malignant pleural disease requires examination of tissue samples.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Multivariate Analysis, Pleural Thickening, Pleural Thickness, Pericardium, Diaphragm, Mediastinum, CT Scan.

Related studies

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• Focal pleural thickening mimicking pleural plaques on chest computed tomography: tips and tricks — K.M. Alfudhili, D.A. Lynch, et al. (2016)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)
• Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases — D.A. Lynch, G. Gamsu, et al. (1989)
• Computed tomography in the diagnosis of asbestos-related thoracic disease — G. Gamsu, D.R. Aberle, et al. (1989)
• The usefulness of computed tomography in detecting asbestos-related pleural abnormalities in people who had indeterminate chest radiographs: the Libby, MT, experience — O.I. Muravov, W.E. Kaye, et al. (2005)

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