Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma

Our plain-English summary of Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma, by L.T. Nickell, J.P. Lichtenberger, L. Khorashadi, et al (Radiographics, 2014).

The study

• Authors: L.T. Nickell, J.P. Lichtenberger, L. Khorashadi, G.F. Abbott, B.W. Carter
• Journal: Radiographics
• Published: 2014;34(6):1692-706
• Type of article: Review
• Cited by: 71 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9-17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease.

In plain English

This article was a narrative review written for radiologists, not a new study of patients. The authors reviewed published literature on malignant pleural mesothelioma (MPM). They described how it appears on chest radiography, CT, thoracic MR imaging and PET/CT, related these findings to the International Mesothelioma Interest Group TNM staging system, and discussed treatment by stage. As background, they cited earlier work reporting that MPM is associated with asbestos exposure in approximately 40%–80% of patients, and stated that asbestos-related pleural plaques are not premalignant. Citing earlier studies, they reported that MR imaging was more accurate than CT for detecting invasion of the chest wall and endothoracic fascia (69% vs 46%) and of the diaphragm (82% vs 55%). One cited study found a PET/CT accuracy of 1.0 for stage II and stage III disease, compared with 0.77 and 0.75 for CT. Mediastinoscopy was reported as more accurate than CT for lymph node staging (93% vs 67%). The authors concluded that CT remains the primary imaging method, with MR imaging complementary for detecting invasion and PET/CT useful for showing lymph node and metastatic spread.

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 (educational article) of the imaging features, staging and treatment of malignant pleural mesothelioma, illustrated with images from individual patients
• Who was studied: No study population. The review draws on published literature and shows images from individual patients with MPM. The number of patients pictured is not stated, and no study period or setting is given.
• Exposure: Asbestos is discussed only as background risk. The article mentions serpentine fibers (chrysotile) and amphibole fibers (amosite, crocidolite), and cites earlier work that MPM is associated with asbestos exposure in approximately 40%–80% of patients. The review did not itself study exposure.
• Main results:
  • The authors described chest CT as the imaging method of choice for evaluating MPM.
  • Citing an earlier study, the authors reported that thoracic MR imaging was more accurate than CT for identifying invasion of the chest wall and endothoracic fascia (69% vs 46%) and diaphragmatic invasion (82% vs 55%).
  • Citing an earlier study of stage II and stage III disease, the authors reported the following accuracies: PET/CT 1.0; CT 0.77 (stage II) and 0.75 (stage III); PET 0.86 (stage II) and 0.83 (stage III); thoracic MR imaging 0.8 (stage II) and 0.9 (stage III).
  • Citing an earlier study, the authors reported that lymph node sampling by mediastinoscopy was more accurate than CT for staging MPM: sensitivity 80% vs 60%, specificity 100% vs 71%, and accuracy 93% vs 67%.
  • Citing earlier work, the authors reported that FDG uptake on PET was significantly higher in MPM than in benign pleural diseases.
  • The authors stated that asbestos-related pleural plaques may be present in MPM but are not premalignant.
• The authors' conclusion: The authors concluded that CT remains the primary imaging method for evaluating MPM, that thoracic MR imaging is complementary to CT for identifying invasion of the chest wall, mediastinum and diaphragm, and that PET/CT is useful for showing lymph node and metastatic disease.

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: Staging, Pleural Mesothelioma, Pleura, Asbestos Exposure, Prognosis, Median Survival, Mesothelioma, Overall Survival.

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• Malignant pleural mesothelioma: role of CT, MRI, and PET/CT in staging evaluation and treatment considerations — M.T. Truong, C. Viswanathan, et al. (2013)
• 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)
• 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)
• The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma — V.W. Rusch, K. Chansky, et al. (2016)

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