Malignant pleural mesothelioma: role of CT, MRI, and PET/CT in staging evaluation and treatment considerations

Our plain-English summary of Malignant pleural mesothelioma: role of CT, MRI, and PET/CT in staging evaluation and treatment considerations, by M.T. Truong, C. Viswanathan, M.B. Godoy, et al (Seminars in Roentgenology, 2013).

The study

• Authors: M.T. Truong, C. Viswanathan, M.B. Godoy, B.W. Carter, E.M. Marom
• Journal: Seminars in Roentgenology
• Published: 2013;48(4):323-34
• Type of article: Review
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This narrative review, by radiologists at the University of Texas M.D. Anderson Cancer Center, discussed imaging, staging and treatment of malignant pleural mesothelioma (MPM). The authors reported that MPM is associated with occupational asbestos exposure in 40%-80% of patients, has an annual United States incidence of 3000 cases, and has a median survival of 9-17 months after diagnosis. They summarized published evidence on chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT for T, N and M staging under the International Mesothelioma Interest Group system. Cited findings included: MRI was more accurate than CT for invasion of the endothoracic fascia or a single chest wall focus (69% vs 46%) and of the diaphragm (82% vs 55%). PET/CT detected extrathoracic metastases in about 25% of patients being evaluated for surgery. PET/CT upstaged 70% of patients in one study. The review also covered chemotherapy, including cisplatin with pemetrexed (median survival 12.1 vs 9.3 months), extrapleural pneumonectomy versus pleurectomy/decortication, radiation therapy, targeted agents, response assessment with modified RECIST and PET, the biomarkers mesothelin-related peptide, megakaryocyte potentiation factor and osteopontin, and complications of therapy. The authors concluded that CT is the primary imaging modality for staging. MRI complements CT for chest wall invasion or transdiaphragmatic extension. PET/CT is useful for nodal and distant metastases but limited for the primary tumor. They added that the role of PET in predicting treatment response and prognosis shows promise and requires further studies.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a narrative review, not an original study, written by radiologists at the University of Texas M.D. Anderson Cancer Center. It described how CT, MRI and PET/CT are used to stage malignant pleural mesothelioma (MPM) and how imaging relates to treatment decisions. The authors summarized earlier published studies and did not collect new data. Citing other work, the background noted that MPM is associated with occupational asbestos exposure in 40%-80% of patients. Among the cited findings: in one study of 43 patients, mediastinoscopy had sensitivity, specificity and accuracy of 80%, 100% and 93% for lymph node spread, compared with 60%, 71% and 67% for CT. In another study, MRI was more accurate than CT for the endothoracic fascia or a single chest wall focus (69% vs 46%) and for the diaphragm (82% vs 55%). The authors described CT as the imaging method of choice for initial staging. They concluded that PET/CT is useful for finding nodal and distant spread but is limited in staging the primary tumor.

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 (CT, MRI, PET/CT), staging and treatment of malignant pleural mesothelioma; no new data were collected
• Who was studied: No study population of its own; the review summarizes published studies and illustrative cases of patients with malignant pleural mesothelioma
• Exposure: Not an exposure study. The background section, citing other work, notes that MPM is associated with occupational asbestos exposure in 40%-80% of patients and names amphiboles (amosite, crocidolite) and serpentine (chrysotile)
• Main results:
  • The authors described CT as the imaging modality of choice for initial staging and surveillance, despite its limitations
  • Cited study (Schouwink et al., 43 patients with MPM): mediastinoscopy had sensitivity, specificity and accuracy of 80%, 100% and 93%, compared with 60%, 71% and 67% for CT
  • Cited study: MRI was more accurate than CT for the endothoracic fascia or a single chest wall focus (69% vs 46%) and for the diaphragm (82% vs 55%)
  • Cited study (Rice et al.): laparoscopy identified transdiaphragmatic invasion or peritoneal metastases in 10 of 109 (9%) patients, compared with 3 of 109 identified by cross-sectional imaging
  • Cited study: PET/CT detected extrathoracic metastases in approximately 25% of patients being evaluated for surgery
  • Cited phase III trial (456 patients): patients given cisplatin plus pemetrexed had longer median overall survival than those given cisplatin alone (12.1 vs 9.3 months)
• The authors' conclusion: The authors concluded that integrated PET/CT is useful in detecting nodal and distant metastatic disease but is limited in staging the primary tumor
• Limitations the authors state:
  • The authors note that imaging is limited in determining the true extent of MPM
  • The authors note that the low incidence of MPM makes it hard to enroll patients in clinical trials, which limits evaluation of treatments

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, Asbestos Exposure, Median Overall Survival, Mesothelioma, Endothoracic Fascia, Diaphragm, Chemotherapy.

Related studies

• 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)
• Use of computed tomography and positron emission tomography/computed tomography for staging of local extent in patients with malignant pleural mesothelioma — T. Frauenfelder, P. Kestenholz, et al. (2015)
• Prognostic value of 18F-FDG standard uptake value by integrated PET/CT in the staging of malignant pleural mesothelioma — G. Genestreti, A. Moretti, et al. (2012)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Diagnostic accuracy of sequential co-registered PET+MR in comparison to PET/CT in local thoracic staging of malignant pleural mesothelioma — K. Martini, A. Meier, et al. (2016)
• FDG PET/CT in the management of primary pleural tumors and pleural metastases — M. Kruse, S.J. Sherry, et al. (2013)

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