Malignant pleural disease

Our plain-English summary of Malignant pleural disease, by L. Bonomo, B. Feragalli, R. Sacco, et al (European Journal of Radiology, 2000).

The study

• Authors: L. Bonomo, B. Feragalli, R. Sacco, B. Merlino, M.L. Storto
• Journal: European Journal of Radiology
• Published: 2000;34(2):98-118
• Type of article: Review
• Cited by: 60 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or gastric carcinoma. Primary pleural neoplasms are less common, although they have developed notoriety since the up-surge of malignant mesothelioma and the knowledge of its connection to asbestos exposure. Other malignant primary tumors include localized fibrous tumor and pleural liposarcoma. In most patients with diffuse malignant pleural disease the chest radiograph shows pleural effusion with or without pleural thickening. Computed tomography (CT) usually provides precise localization and extent of the disease and may be of value in assessing chest wall and mediastinal involvement. In specific situations, magnetic resonance (MR) may be useful as a problem-solving tool when CT findings of chest wall or diaphragmatic invasion are equivocal or in patients with contraindication to intravenous administration of ionic contrast material.

In plain English

This article reviewed how imaging shows cancers involving the pleura, the lining around the lungs. It did not report a new study of a patient group; it summarized earlier published studies, illustrated with scans of individual patients. Much of the review covered malignant pleural mesothelioma. Citing other studies, it stated that about 80% of these tumors occur in people exposed to asbestos and that 20% of patients have no history of asbestos exposure. It stated that the amphiboles appear to be 15 times more potent than chrysotile in causing mesothelioma. On pleural plaques, it said there is no evidence they are premalignant, although their presence suggests an increased probability of mesothelioma. It described chest X-ray, CT and MR findings and cited a study of 95 patients that found CT and MR nearly equivalent for staging. It noted localized fibrous tumor is not related to asbestos exposure. It also covered liposarcoma, metastases, lymphoma and invasive thymoma. The authors concluded that CT usually provides precise localization and extent of disease, and that MR may be useful as a problem-solving tool in specific situations.

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 published literature on imaging of malignant pleural tumors, illustrated with images from individual patients
• Who was studied: No systematically studied patient group of its own. The review summarized published studies on primary pleural tumors (mainly malignant pleural mesothelioma, plus localized fibrous tumor and pleural liposarcoma) and secondary tumors (metastases, lymphoma, invasive thymoma). It is illustrated with radiographs, CT and MR images of individual patients, some with surgical confirmation.
• Exposure: No exposure was studied. As background, the review discussed asbestos as a cause of mesothelioma, naming chrysotile and the amphiboles (crocidolite, amosite, tremolite), and listed other proposed causes such as zeolite, irradiation and Simian virus 40.
• Main results:
  • Citing earlier studies, the review stated that approximately 80% of malignant pleural mesotheliomas occur in individuals exposed to asbestos.
  • Citing earlier studies, the review stated that 20% of patients with mesothelioma have no history of asbestos exposure and no excess of asbestos fibers in their lungs.
  • Citing an earlier study, the review stated that the amphiboles appear to be 15 times more potent than chrysotile in the development of mesothelioma.
  • Citing an earlier study, the review stated there is no evidence that pleural plaques are premalignant or a precursor of mesothelioma, but that their presence suggests an increased probability of mesothelioma occurring.
  • In a cited CT series of 50 patients with malignant pleural mesothelioma (Kawashima and Libshitz), pleural thickening was found in 92% of patients before treatment.
  • In a cited study of 74 patients with diffuse pleural disease (39 malignant, 35 benign) by Leung et al., using one or more CT criteria identified 28 of 39 malignant cases, a sensitivity of 72% and specificity of 83%.
  • In a cited study of 188 patients with mesothelioma (Boutin), thoracoscopic biopsy had a diagnostic sensitivity of 98.4%.
  • In a cited review of 95 patients with malignant pleural mesothelioma (Heelan et al.), CT and MR imaging were of nearly equivalent diagnostic accuracy in staging.
  • Citing an earlier study, the review stated that localized fibrous tumor of the pleura is not related to asbestos exposure.
• The authors' conclusion: The authors concluded that CT usually provides precise localization and extent of malignant pleural disease and may help assess chest wall and mediastinal involvement. They said MR may be useful as a problem-solving tool in specific situations.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Pleura, Bronchogenic Carcinoma, Carcinoma, Malignant Mesothelioma, Asbestos Exposure, Solitary Fibrous Tumor, Chest X-Ray.

Related studies

• Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases — D.A. Lynch, G. Gamsu, et al. (1989)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Asbestos and malignant disease — R. Barnes (1972)
• Asbestos related disease — H.L. Hardy (1965)
• Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire — Ó. Arrieta, C. Núñez-Valencia, et al. (2012)
• Clinicopathologic features and prognostic significance of lung tumours with mixed histologic patterns — E. Cakir, E. Demirag, et al. (2009)

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