Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up

Our plain-English summary of Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up, by P.J. Guest, R.H. Reznek, D. Selleslag, et al (Clinical Radiology, 1992).

The study

• Authors: P.J. Guest, R.H. Reznek, D. Selleslag, R. Geraghty, M. Slevin
• Journal: Clinical Radiology
• Published: 1992;45(2):79-84
• Cited by: 39 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Computed tomography (CT) was performed on 15 patients with proven peritoneal mesothelioma. Eight of these patients underwent follow-up CT. It was found that a discrete and measurable mass is unusual in comparison with the common occurrence of ascites and that therefore CT has little role in quantifying the disease. Ascites is usually a prominent feature. Other features (e.g. omental infiltration) were evaluated and these could be used to assess disease progression.

In plain English

The authors reviewed computed tomography (CT) scans of 15 patients with proven peritoneal mesothelioma. Eight of them had follow-up scans 3 to 8 months after starting treatment. Patients were aged 26 to 71, and 13 were men. Ten had a definite history of significant asbestos exposure, in jobs such as lagging, roofing and insulation engineering or, for one woman, from living next door to an asbestos factory. Ascites (fluid in the abdomen) was a prominent feature in 13 of 15 patients. Only three patients had a discrete mass that could be measured. None of those three had ascites at first, although one developed fluid on follow-up. Omental infiltration thick enough to measure, called an omental 'cake', was seen in 6 of 15 patients at presentation. Pleural disease was seen in 12 of 15. On follow-up, seven of eight patients showed increasing disease, but this was judged by general impression rather than precise measurement. The authors found no CT feature that was diagnostic. They concluded that CT is at best suggestive for diagnosis but remains a valuable non-invasive way to follow the disease, although precise measurement is unusual.

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: Case series: a review of initial and follow-up CT scans (23 studies in total) and hospital case records of patients with peritoneal mesothelioma
• Who was studied: 15 patients with proven peritoneal mesothelioma (13 male, 2 female, aged 26 to 71). The authors were at St Bartholomew's Hospital and Homerton Hospital, London, and 3 of the 23 CT studies were done at other hospitals. The article does not state where patients were recruited. All received chemotherapy, and 8 had follow-up CT. Study dates are not given.
• Exposure: 10 patients had a definite history of significant asbestos exposure, in occupations such as laggers, roofers and insulation engineers, or, for one woman, from living next door to an asbestos factory for many years. Two maintenance engineers had possible but unproven exposure. The other three were a computer programmer, a family doctor and a cleaner. Fiber types are not stated.
• Main results:
  • Ascites was a prominent feature in 13 of 15 patients
  • Only 3 of 15 patients had discrete masses that could be measured (7 x 9, 5 x 14 and 7 x 15 cm). None of these three had associated ascites at first, although fluid accumulated on follow-up in one.
  • The peritoneum of the abdominal wall was involved in 10 of 15 patients. Discrete peritoneal nodules were seen at presentation in 4 of 15.
  • At presentation, omental infiltration was measurable in thickness (an omental 'cake') in 6 of 15 patients. Cakes developed in two others on follow-up and measured up to 5 cm thick.
  • Pleural disease occurred in 12 of 15 patients. Pleural thickening, plaques or calcification were present in 10 of 15.
  • All 10 patients with a history of asbestos exposure showed some evidence of it on chest radiographs or chest CT
  • Of the 8 patients with follow-up CT, 7 showed evidence of increasing disease
  • The authors found no CT features that could be regarded as diagnostic
  • Twelve of the 15 patients died between 2 and 12 months after diagnosis
• The authors' conclusion: The authors concluded that CT is a valuable non-invasive way to assess the disease during follow-up, in the absence of other objective measures, but that precise quantification of the disease is unusual. They also stated that CT is at best suggestive for diagnosis and that histological confirmation will always be required.
• Limitations the authors state:
  • Disease progression on follow-up was judged by general impression of increased disease bulk, not by the precise measurements required for conventional oncology response assessment
  • Measurable masses were infrequent, which made the disease difficult to quantify on CT

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Disease Progression.

Related studies

• Ultrasonography and computed tomography of peritoneal mesothelioma — H.C. Yeh, A.P. Chahinian (1980)
• A case of malignant peritoneal mesothelioma suggesting the utility of combining double-contrast radiography and endoscopy with computed tomography for diagnosis — H. Saito, S. Hasuda, et al. (2017)
• Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis — J.D. Rivard, W.J. Temple, et al. (2014)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Cystic appearance of a malignant peritoneal mesothelioma by ultrasonography and computed tomography: a case report — K.W. Preidler, H. Steiner, et al. (1994)
• 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography fused imaging in malignant mesothelioma patients: looking from outside is not enough — E. Roca, S. Laroumagne, et al. (2013)

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