Diffuse neoplasms of the pleural serosa

Our plain-English summary of Diffuse neoplasms of the pleural serosa, by L. Cardinale, F. Ardissone, F. Asteggiano, et al (La Radiologia Medica, 2013).

The study

• Authors: L. Cardinale, F. Ardissone, F. Asteggiano, E.M. Laugelli, D. Penna, C. Fava
• Journal: La Radiologia Medica
• Published: 2013;118(3):366-78
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study describes the diffuse neoplastic conditions that may affect pleural membranes. These include mesothelioma, the most important and common malignancy of pleural origin, and metastatic involvement by carcinomas, lymphomas and thymomas. On the basis of diagnostic imaging, we identify the distinctive features of pleural involvement by each of these conditions and provide elements enabling accurate differential diagnosis. Finally, we discuss the best diagnostic approach in the case of suspected primary or secondary neoplastic involvement of pleural membranes.

In plain English

This article was a narrative review and reported no new patient study. It described how diffuse pleural tumours (of the lining around the lungs) appear on X-ray, CT, MR imaging, PET and ultrasound. It covered malignant pleural mesothelioma and pleural spread from carcinomas, lymphomas and thymomas. Citing earlier sources, the review linked mesothelioma to occupational or environmental asbestos exposure, with a latency of at least 20 years. It gave rates of 15 per million in men and three per million in women. Plaques or calcifications from asbestos exposure may be present in 20% of mesothelioma cases. Some CT signs, such as circumferential thickening, had high specificity (88% to 100%) but low sensitivity (30% to 60%). These signs could not separate mesothelioma from diffuse pleural metastases. Citing guidelines, the review stated that cytology of thoracentesis fluid diagnoses primary or secondary pleural malignancy in about 60% of cases. It stated that thoracoscopy has a diagnostic yield of almost 100%. For mesothelioma, the authors noted that no comparative studies of multislice CT and MR imaging had been conducted. Even so, they suggested limiting MR imaging to equivocal cases needing higher contrast resolution, citing improvements in CT.

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: Narrative review of imaging features of diffuse pleural neoplasms, illustrated with patient images; no original study data
• Who was studied: No study population. The review drew on published literature and was illustrated with images from individual patients shown in figures, such as a 72-year-old woman with malignant pleural mesothelioma.
• Exposure: No exposure was studied. Asbestos exposure, occupational or environmental, was mentioned as background for malignant pleural mesothelioma. No fiber types were named.
• Main results:
  • Citing earlier sources, the review stated that the latency between asbestos exposure and mesothelioma onset is at least 20 years, and that rates are 15 cases per million in men and three cases per million in women.
  • Citing an earlier source, the review stated that plaques or calcifications indicating asbestos exposure may be present in 20% of malignant pleural mesothelioma cases.
  • Citing earlier studies, the review reported specificities for CT signs of neoplastic pleural thickening: circumferential involvement 100%, nodularity 94%, thickness over 10 mm 94%, and mediastinal border involvement 88%.
  • The review stated that the sensitivity of these CT signs is low, 30% to 60% depending on the series. It also stated that these features of mesothelioma cannot be differentiated from diffuse pleural metastases.
  • Citing guidelines, the review stated that cytological analysis of fluid obtained by thoracentesis provides a diagnosis of primary or secondary pleural malignancy in about 60% of cases.
  • The review stated that thoracoscopy has a diagnostic yield of almost 100%.
• The authors' conclusion: In discussing malignant pleural mesothelioma, particularly assessment of the diaphragm and chest wall, the authors suggested limiting MR imaging to equivocal cases requiring higher contrast resolution. Their reasons were improvements in CT, its wider availability and its faster acquisition.
• Limitations the authors state:
  • The authors stated that no comparative studies of multislice CT and MR imaging had been conducted. Their suggestion about limiting MR imaging was therefore not based on direct comparisons.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Mesothelioma, Carcinoma, Differential Diagnosis.

Related studies

• Lymphoproliferative conditions of the serosa — R. Attanoos (2012)
• Epithelioid lesions of the serosa — S. Anttila (2012)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Imaging in pleural mesothelioma: A review of the 14th International Conference of the International Mesothelioma Interest Group — S.G. Armato, R.J. Francis, et al. (2019)
• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)

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