Malignant Pleural Mesothelioma: Diagnosis, Staging, Pitfalls and Follow-up

Our plain-English summary of Malignant Pleural Mesothelioma: Diagnosis, Staging, Pitfalls and Follow-up, by E.G. Odisio, E.M. Marom, G.S. Shroff, et al (Seminars in Ultrasound, CT, and MR, 2017).

The study

• Authors: E.G. Odisio, E.M. Marom, G.S. Shroff, C.C. Wu, A.P.A. Benveniste, M.T. Truong, M.F. Benveniste
• Journal: Seminars in Ultrasound, CT, and MR
• Published: 2017;38(6):559-570
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is the most common primary neoplasm of the pleura. Imaging evaluation is essential in diagnosis, staging, and assessment of treatment response in malignant pleural mesothelioma. Computed tomography is the most commonly used modality for tumor staging. Assessment of tumor extension and lymph node involvement is essential in imaging evaluation as locally advanced tumors are amenable to resection. Knowledge of the full imaging spectrum of this rare disease, differential diagnosis, staging classification, and the current guidelines for diagnostic evaluation and follow-up are essential in accurate interpretation to optimize patient management.

Copyright © 2017 Elsevier Inc. All rights reserved.

In plain English

This narrative review by radiologists covered imaging in the diagnosis, staging and follow-up of malignant pleural mesothelioma (MPM). It did not report an original cohort study or clinical trial; its figures show images from individual patients. Citing earlier work, the authors described MPM as strongly associated with asbestos exposure, noting a history of occupational exposure in 40% to 80% of patients and a median survival of 4 to 18 months. They described CT as the imaging method of choice. They cited an earlier study in which circumferential or nodular pleural thickening on CT indicated malignant pleural disease. They cited another study in which MRI was more accurate than CT for tumor spread into the endothoracic fascia (69% vs 46%) and the diaphragm muscle (82% vs 55%). They summarized the proposed 8th edition staging system, based on 3,519 cases from 29 centers. They also described PET/CT for finding spread and the modified RECIST method for measuring treatment response. The authors concluded that knowing the full imaging range, differential diagnosis, staging and current guidelines is essential for accurate interpretation.

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 in malignant pleural mesothelioma. It reports no original cohort study or clinical trial. It summarizes published studies and the staging and response guidelines, and its figures show images, measurements and follow-up from individual patients.
• Who was studied: No study population. The review draws on published studies. Its figures show findings in individual patients with malignant pleural mesothelioma (for example, a 63-year-old man with prior asbestos exposure) and in patients with tumors that mimic it.
• Exposure: The review discusses asbestos exposure in general terms as the main risk factor for MPM, citing earlier work. It names occupational exposure, paraoccupational exposure (wives laundering asbestos workers' clothes) and environmental exposure from natural sources. It notes thoracic radiotherapy as an additional risk factor and Simian virus 40 as a possible cofactor.
• Main results:
  • Citing earlier work, the review states that MPM is associated with a history of occupational asbestos exposure in 40% to 80% of patients.
  • Citing earlier work, the review states that median survival for a patient with MPM is between 4 and 18 months.
  • The review describes CT as the imaging modality of choice for diagnosis, staging, treatment planning and follow-up of MPM.
  • Citing Leung et al., four CT signs were indicators of malignant pleural disease: circumferential pleural thickening, nodular pleural thickening, parietal pleural thickening greater than 1 cm, and mediastinal pleural involvement. Their specificities were 100%, 94%, 94% and 88%, respectively. Pleural plaques suggest a benign cause.
  • Citing an earlier comparison study, MRI was more accurate than CT for endothoracic fascia involvement (69% vs 46%) and for diaphragmatic muscle invasion (82% vs 55%).
  • Citing earlier studies, pleural fluid cytology has a sensitivity below 30%. Image-guided percutaneous biopsy has a sensitivity of 86%, and biopsy at thoracoscopy 94% to 100%.
  • The proposed 8th edition TNM staging revisions described in the review are based on cases collected prospectively from 29 centers on 4 continents, 3,519 cases in total.
  • Under modified RECIST for MPM, as described in the review, tumor thickness is measured at six sites on CT. A reduction of at least 30% on two CT scans 4 weeks apart is a partial response. An increase of 20% over the lowest measurement is progressive disease.
• The authors' conclusion: The authors concluded that knowledge of the full imaging spectrum of MPM, its differential diagnosis, staging classification, and current guidelines for diagnostic evaluation and follow-up is essential for accurate interpretation to optimize patient management.

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, Staging, Neoplasm, Pleura, Differential Diagnosis.

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