CT appearances of pleural tumours

Our plain-English summary of CT appearances of pleural tumours, by H.M. Salahudeen, E.T. Hoey, R.J. Robertson, et al (Clinical Radiology, 2009).

The study

• Authors: H.M. Salahudeen, E.T. Hoey, R.J. Robertson, M.J. Darby
• Journal: Clinical Radiology
• Published: 2009;64(9):918-30
• Type of article: Review
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Computed tomography (CT) is the imaging technique of choice for characterizing pleural masses with respect to their location, composition, and extent. CT also provides important information regarding invasion of the chest wall and surrounding structures. A spectrum of tumours can affect the pleura of which metastatic adenocarcinoma is the commonest cause of malignant pleural disease, while malignant mesothelioma is the most common primary pleural tumour. Certain CT features help differentiate benign from malignant processes. This pictorial review highlights the salient CT appearances of a range of tumours that may affect the pleura.

In plain English

This article was a pictorial review. It described how tumours affecting the pleura, the lining around the lungs, look on CT scans, using example images. It reported no new study of patients; the percentages it gave came from earlier studies it cited. It covered benign tumours (lipoma, solitary fibrous tumour) and malignant ones (metastases, malignant mesothelioma, lymphoma, sarcomas). Citing earlier work, it said four CT signs had reported specificities of 100, 94, 94 and 88% for malignancy but low sensitivities of 41, 51, 36 and 56%. The signs were circumferential pleural thickening, nodular thickening, thickening greater than 1 cm, and involvement of the mediastinal pleura. It stated that CT alone cannot reliably tell mesothelioma from metastatic or other primary pleural cancers. It said accompanying findings of asbestos exposure, such as calcified pleural plaques, are seen in 20% of patients with mesothelioma. It stated that more than 80% of patients develop mesothelioma from asbestos exposure. It also said amphibole fibres (crocidolite and amosite) carry a stronger association than chrysotile. The authors concluded that CT in many cases can reliably distinguish benign from malignant patterns.

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: Pictorial (narrative) review of CT appearances of pleural tumours, illustrated with example images; no original study data
• Who was studied: No study population. The review summarised published literature and showed CT images of individual patients, some credited to named clinicians, to illustrate a range of benign and malignant pleural tumours
• Exposure: Not a study of exposure. In its background on mesothelioma, the review stated (citing other work) that amphibole fibres (crocidolite and amosite) carry a stronger association with mesothelioma than chrysotile
• Main results:
  • Citing earlier studies, the review gave figures for four CT signs: circumferential pleural thickening, nodular pleural thickening, pleural thickening greater than 1 cm, and involvement of the mediastinal pleural surface. Their specificities for malignancy were 100, 94, 94 and 88%, and their sensitivities were 41, 51, 36 and 56%, respectively
  • The review stated that CT appearances alone cannot reliably differentiate mesothelioma from metastatic or other primary pleural malignancies. Diagnosis is made from pleural fluid cytology or pleural biopsy
  • Citing earlier work, the review stated that circumferential thickening, fissural involvement and contraction of the hemithorax favour mesothelioma over pleural metastases
  • Citing earlier work, the review stated that concomitant findings of asbestos exposure, with calcified pleural plaques given as an example, are seen in 20% of patients with mesothelioma
  • Citing earlier work, the review stated that more than 80% of patients develop mesothelioma as a result of asbestos exposure
  • Citing earlier work, the review stated that CT has greater than 90% sensitivity for excluding T4 mesothelioma (mediastinal, chest wall or diaphragmatic invasion)
  • Citing earlier work, the review stated that the lifetime risk of mesothelioma in a population with asbestos exposure is estimated at 4.5 to 10%
• The authors' conclusion: The authors concluded that CT is widely used to investigate suspected pleural disease and in many cases can reliably distinguish benign from malignant patterns. They also concluded that it is useful for guiding biopsy and for showing chest wall, mediastinal and diaphragmatic invasion

Topics

Medical terms in this study, explained in our Lexicon: Pleura, Adenocarcinoma, Malignant Mesothelioma.

Related studies

• Surgery for primary intrapericardial tumors in adults — S. Taguchi, R. Yozu (2013)
• Costal pleura: appearances at high-resolution CT — J.G. Im, W.R. Webb, et al. (1989)
• Pleural tumours and tumour-like lesions — F. Aluja Jaramillo, F. Gutierrez, et al. (2018)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Neoplastic Pericardial Disease — J.J. Maleszewski, N.S. Anavekar (2017)
• Application of markers in the diagnosis of soft tissue tumours — P.J. Roholl, A.S. De Jong, et al. (1985)

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