From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation

Our plain-English summary of From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation, by B.H. Miller, M.L. Rosado-de-Christenson, A.C. Mason, et al (Radiographics, 1996).

The study

• Authors: B.H. Miller, M.L. Rosado-de-Christenson, A.C. Mason, M.V. Fleming, C.C. White, M.J. Krasna
• Journal: Radiographics
• Published: 1996;16(3):613-44
• Type of article: Review
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm that typically affects individuals occupationally exposed to asbestos through a variety of industries. The patients experience an insidious onset of symptoms, including dyspnea, chest pain, cough, malaise, and weight loss. The pathologic diagnosis of MPM is difficult, and special stains or immunohistochemical or ultrastructural analysis may be required to differentiate MPM from metastatic adenocarcinoma. The tumor affects both the parietal and visceral pleural surfaces and progresses to encase the lung and invade the lung, mediastinum, and chest wall. Radiologically, MPM manifests as unilateral pleural effusion, pleural nodules, or pleural masses. Imaging studies are useful for diagnosis and staging in patients who are potential surgical candidates. Although a variety of multimodality therapies are available and radical surgical procedures have been developed, the prognosis remains dismal.

In plain English

This article was a review in a continuing-education series from the Armed Forces Institute of Pathology. It summarized published literature on malignant pleural mesothelioma (MPM) and illustrated it with X-ray, scan and tissue images from individual patients. It reported no new study data. Most of the study statistics it gave were credited to earlier research it cited. The review described asbestos fiber types and stated that it is postulated that pure chrysotile does not cause MPM, and that tremolite contaminants may be responsible for tumors in people exposed to chrysotile. It noted that a history of occupational asbestos exposure is found in only 40%-80% of patients with MPM. On imaging, it reported diffuse, one-sided pleural thickening in up to 60% of patients. It stated that several other diseases cannot be reliably told apart from MPM by imaging alone. It cited a study of 188 patients in which thoracoscopic biopsy had a sensitivity of 98.4%, compared with 26% for pleural fluid cytology. The authors described MPM as almost uniformly fatal. They concluded that imaging is useful for diagnosis and staging in patients who may be candidates for surgery.

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 article (continuing-education radiologic-pathologic correlation review) summarizing published literature, illustrated with images from individual patients; no original study data
• Who was studied: No study population. The review summarized published studies of patients with malignant pleural mesothelioma and illustrated them with images from individual patients, for example a 66-year-old male shipyard worker.
• Exposure: Asbestos exposure in general, mainly occupational. The review discusses crocidolite, amosite, chrysotile, tremolite and other amphiboles, high-risk occupations such as insulation work, shipyard work and construction, and non-asbestos factors such as erionite.
• Main results:
  • The review stated, as a hypothesis, that pure chrysotile does not cause MPM, and that amphibole contaminants such as tremolite may be responsible for tumors in people exposed to chrysotile.
  • Amphibole contaminants such as tremolite may be responsible for tumor development in individuals exposed to chrysotile (as stated by the review, citing earlier work).
  • Citing earlier literature, the review stated that a history of occupational asbestos exposure is found in only 40%-80% of patients with MPM.
  • Citing earlier literature, the review stated that diffuse, unilateral pleural thickening occurs in up to 60% of patients with MPM.
  • Infections, other pleural malignancies and metastases to the pleura may produce pleural thickening or masses that cannot be reliably differentiated from MPM with imaging studies alone.
  • The review cited a study by Boutin and colleagues of 188 patients with MPM. In that study, the sensitivity of pleural fluid cytology was 26% and the sensitivity of thoracoscopic biopsy was 98.4%.
  • Thoracoscopic biopsy had a sensitivity of 98.4% in the cited study of 188 patients.
  • The review described CT as, although not perfect, the most accurate radiologic method for initial staging and follow-up of MPM.
  • The review described MPM as almost uniformly fatal.
• The authors' conclusion: The authors concluded that imaging studies are useful for diagnosis and staging in patients who are potential surgical candidates, and that despite multimodality therapies and radical surgery the prognosis remains dismal.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Dyspnea, Adenocarcinoma, Mediastinum, Pleural Effusion, Staging, Prognosis.

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