Computed tomography in the assessment of malignant mesothelioma of the pleura

Our plain-English summary of Computed tomography in the assessment of malignant mesothelioma of the pleura, by M.R. Law, A. Gregor, J.E. Husband, et al (Clinical Radiology, 1982).

The study

• Authors: M.R. Law, A. Gregor, J.E. Husband, I.H. Kerr
• Journal: Clinical Radiology
• Published: 1982;33(1):67-70
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000683).

Abstract

Computed tomography (CT) and plain radiography have been performed on 32 patients with malignant mesothelioma of the pleura, in order to assess the extent of disease and suitability for radical treatment. A comparison of the assessments by the two techniques is reported, with confirmation from either thoracotomy or post-mortem findings available in 16 cases. CT was found to be more sensitive than plain radiology in the detection of pleural effusions, although routine lateral decubitus radiographs has not been performed. The two techniques were equally effective in detecting involvement by tumour of the lateral chest wall, mediastinum and lung, with no false positive assessments by either technique, and few false negative assessments. Disease was shown to be extensive and gross at presentation in mesothelioma, so that the greater sensitivity of CT was of no advantage. Diaphragmatic involvement by tumour was accurately assessed by plain radiology but there were frequent false negative assessments by CT, possibly due to difficulty of interpretation of the curved diaphragm on the cross-sectional CT image. In this study CT offered little advantage over conventional radiology.

In plain English

This study compared computed tomography (CT) scans with ordinary chest X-rays for judging how far malignant mesothelioma of the pleura had spread. It included 32 patients (27 men and five women) being assessed for possible radical treatment. The article did not report the patients' asbestos exposure. In 16 patients, the imaging was checked against findings at surgery or autopsy. Fluid around the lung (pleural effusion) was judged absent on CT in three patients but on X-ray in 10. The two methods performed similarly for tumour in the chest wall, mediastinum and lung. Neither method gave a false positive reading in the patients who could be checked at surgery or autopsy. For the diaphragm, CT showed no involvement in 14 of 32 patients, compared with three on X-ray. All five of the CT-negative cases that could be checked were false negatives, against one false negative for X-ray. The authors concluded that CT offered little advantage over conventional radiology in this disease, which is usually extensive at presentation. They also concluded that CT assessments of the diaphragm may need cautious interpretation.

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: Comparison of two imaging methods (CT versus plain chest radiography) in a series of patients, with surgical or autopsy confirmation in some cases
• Who was studied: 32 patients with histologically confirmed malignant mesothelioma of the pleura (27 males, five females; mean age 56, range 36-70). Tumours were right-sided in 19 and left-sided in 13. Patients were assessed at the Brompton Hospital, London. The study dates are not given.
• Exposure: Not reported. The study examined imaging methods, not asbestos exposure.
• Main results:
  • Among all 32 patients, pleural effusion was judged absent on CT in three cases but on plain radiology in 10 cases.
  • CT and plain radiology were equally effective in detecting tumour involvement of the lateral chest wall, mediastinum and lung.
  • In the 16 patients whose imaging was checked against surgery or autopsy findings, neither method was shown to give a false positive assessment.
  • Assessment of lung involvement by both techniques was confirmed by post-mortem findings in eight of the nine autopsied cases.
  • Among the 32 patients, CT showed no evidence of diaphragmatic involvement in 14, compared with three on conventional radiology.
  • Five of the 14 CT-negative diaphragm cases could be checked against surgery or autopsy, and all five were false negatives. Plain radiology had one false negative.
  • With CT, diaphragmatic involvement was judged absent in five of 19 (26%) right-sided tumours but in nine of 13 (69%) left-sided tumours.
• The authors' conclusion: The authors concluded that CT offers little advantage over conventional radiology in this disease, which is usually extensive at presentation. They added that CT assessments of diaphragmatic involvement may need cautious interpretation.
• Limitations the authors state:
  • Lateral decubitus (side-lying) radiographs were not taken routinely, and these might have improved detection of effusions on plain radiology.
  • The authors noted that the absence of false positives was perhaps not surprising given how advanced the disease was, and that correct negative findings occurred only four times.
  • Lung involvement could not be checked at surgery and was compared with autopsy findings only.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Thoracotomy, Pleural Effusion, Mediastinum, Mesothelioma, Diaphragm.

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