Diagnostic Imaging and workup of Malignant Pleural Mesothelioma

Our plain-English summary of Diagnostic Imaging and workup of Malignant Pleural Mesothelioma, by L. Cardinale, F. Ardissone, D. Gned, et al (Acta Bio-medica, 2017).

The study

• Authors: L. Cardinale, F. Ardissone, D. Gned, N. Sverzellati, E. Piacibello, A. Veltri
• Journal: Acta Bio-medica
• Published: 2017;88(2):134-142
• Type of article: Review
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is the most frequent primary neoplasm of the pleura and its incidence is still increasing.This tumor has a strong association with exposure to occupational or environmental asbestos, often after a long latent period of 30-40 years.Plain chest radiography (CXR) is usually the first-line radiologic examination, but the radiographic findings are nonspecific due to its limited contrast resolution and they need to be complemented by other imaging modalities such as computed tomography (CT), magnetic resonance Imaging (MRI), Positron emission tomography-computed tomography (PET-CT) and ultrasound (US).The aim of this paper is to describe the imaging features of this malignancy, underlining the peculiarity of CXR, CT, MRI, PET-CT and US and also focusing on diagnostic workup, based on the literature evidence and according to our experience.

In plain English

This article was a review, which its authors called a pictorial essay, from radiology and thoracic surgery departments in Turin and Parma, Italy. It reported no new patient study. It summarized published research and the authors' hospital experience on how malignant pleural mesothelioma appears on chest X-ray, CT, MRI, PET-CT and ultrasound. Citing earlier studies, the authors reported that a one-sided pleural effusion is the typical chest X-ray finding (30%-80% of patients) and that pleural thickening is the most common CT finding (90%-92% of patients). They cited a 7-year follow-up study of formerly asbestos-exposed workers that found a statistically significant association between pleural plaques seen on CT and the risk of pleural mesothelioma. They noted that CT has shown limited accuracy in staging. Their proposed pathway starts with chest X-ray. Plaques alone need no further tests, unexplained recurrent one-sided effusion calls for contrast CT, and thoracoscopy follows if CT shows nothing. The authors concluded that rational, cost-effective combined use of imaging is crucial for choosing treatment.

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 (pictorial essay) of imaging features of malignant pleural mesothelioma, with a proposed diagnostic pathway; no original patient data
• Who was studied: No patients were studied. The article draws on published literature and the authors' experience at their hospital in Turin, Italy
• Exposure: Not studied. Asbestos exposure (occupational or environmental) is mentioned only as background; no fiber types are named
• Main results:
  • Citing earlier literature, the authors stated that a unilateral pleural effusion is the typical chest X-ray finding at presentation, seen in 30%-80% of patients
  • Citing another study (reference 9), the authors stated that pleural thickening is the most common CT finding, seen in 90%-92% of patients
  • The authors cited a separate 7-year follow-up study of formerly asbestos-exposed workers that observed a statistically significant association between pleural plaques detected on CT and the risk of malignant pleural mesothelioma
  • Citing earlier studies, the authors stated that CT has shown limited accuracy in distinguishing potentially resectable (T3) from unresectable (T4) disease and in identifying intrathoracic lymph node involvement
  • In a cited study of 28 patients (Frauenfelder and colleagues), PET/CT showed higher accuracy than CT for tumor extent (92% vs 84%), while CT showed higher accuracy than PET/CT for lymph node staging (87% vs 78%)
  • In a cited study (Qureshi and colleagues), ultrasound distinguished malignant from benign effusions with an overall sensitivity of 79% and specificity of 100%
  • The authors' proposed pathway begins with chest X-ray. Pleural plaques on chest X-ray need no further tests. Recurrent unilateral effusion with no known cause should be investigated by contrast CT, and recurrent effusion with no visible CT abnormality by video-assisted thoracoscopy
• The authors' conclusion: The authors concluded that each imaging method has strengths and limitations, but that their rational and cost-effective combined use is crucial in determining the most appropriate treatment for patients with malignant pleural mesothelioma

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleura, PET-CT, Ultrasound.

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• Imaging of the pleura — N.L. Müller (1993)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure — S.T. Ahmed, M. Barvo, et al. (2020)
• The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy — S. Tsim, D.B. Stobo, et al. (2017)

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