The role of imaging in malignant pleural mesothelioma

Our plain-English summary of The role of imaging in malignant pleural mesothelioma, by E.M. Marom, J.J. Erasmus, H.I. Pass, et al (Seminars in Oncology, 2002).

The study

• Authors: E.M. Marom, J.J. Erasmus, H.I. Pass, E.F. Patz
• Journal: Seminars in Oncology
• Published: 2002;29(1):26-35
• Type of article: Review
• Cited by: 55 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Imaging plays an essential role in the diagnosis, staging, and follow-up of patients with malignant pleural mesothelioma (MPM). The diagnosis is often suggested by a unilateral pleural mass with a moderate to large pleural effusion seen on chest radiographs, but computerized tomography (CT) is the most frequently used technique for evaluation of the lungs in patients with MPM. CT not only suggests pulmonary metastases typically manifested as nodules or masses, but also can demonstrate underlying lung disease often caused by prior asbestos exposure. Magnetic resonance (MR) imaging may be helpful in selected patients with potentially resectable disease to further examine the local extent of tumor. Imaging with positron emission tomography (PET) using the radionuclide imaging agent (18)F fluoro-deoxyglucose (FDG) takes advantage of a basic property of tumor cells, increased glucose metabolism to identify malignant lesions. PET provides not only anatomic information, especially regarding mediastinal node metastasis, but also biochemical information about the lesion. These imaging modalities help triage patients to the most appropriate diagnostic and treatment options. Following patients after therapy usually relies on chest radiographs, although CT can more accurately describe response to therapy. This review will focus on radiologic evaluation in diagnosing, staging, and follow-up patients with MPM.

Copyright 2002 by W.B. Saunders Company.

In plain English

This article was a review, not a new study. The authors summarized published research on imaging for diagnosing, staging and following patients with malignant pleural mesothelioma. They noted that CT can show lung disease often caused by prior asbestos exposure. Citing an earlier study of 65 patients, the review reported that MR imaging was more accurate than CT for invasion of the diaphragm (82% versus 55%) and of the endothoracic fascia or a single chest wall focus (69% versus 46%). A small earlier study it cited found that FDG-PET separated mesothelioma from benign pleural disease with 91% sensitivity and 100% specificity. The review stated that CT accuracy for lymph nodes remains less than optimal. It also stated that a core needle biopsy with solid tissue is required to confidently establish the diagnosis, with Cope needle biopsy or thoracoscopic surgery (VATS) as alternatives. The authors concluded that imaging plays an important role in suggesting the diagnosis, choosing the biopsy site, staging and following response to therapy. They added that MR imaging may provide additional information in surgical candidates with questionable areas of local tumor extension on CT.

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 (chest radiographs, CT, MR imaging, FDG-PET) in malignant pleural mesothelioma, summarizing previously published studies
• Who was studied: No study population of its own. The review drew on published studies of patients with malignant pleural mesothelioma and was illustrated with images from individual patients, for example a 78-year-old man with epithelial type mesothelioma.
• Exposure: Not an exposure study. Asbestos was mentioned only as background, for example that CT can show underlying lung disease often caused by prior asbestos exposure. No fiber types, products or jobs were discussed.
• Main results:
  • Reported from an earlier study of 65 patients with malignant pleural mesothelioma (not this article's data): for invasion of the diaphragm, CT accuracy was 55% and MR accuracy was 82%.
  • Reported from the same earlier study: for invasion of the endothoracic fascia or a single chest wall focus, CT accuracy was 46% and MR accuracy was 69%.
  • Reported from an earlier small prospective study of patients suspected of having malignant pleural mesothelioma: FDG uptake was significantly higher in mesothelioma than in benign pleural disease, with sensitivity 91% and specificity 100%.
  • The review stated that CT is the most common method for assessing chest lymph nodes, but its accuracy remains less than optimal.
  • The review stated that a core needle biopsy with solid tissue is required to confidently establish the diagnosis.
  • The review stated that, as alternatives, a Cope needle biopsy or video-assisted thoracoscopic surgery (VATS) can be performed to obtain an even larger diagnostic specimen.
  • Reported from earlier studies: diagnostic accuracy was 77% with ultrasound-guided core needle biopsy and 83% with CT guidance.
  • Reported from earlier studies: VATS (video-assisted thoracoscopic surgery) had a diagnostic rate of 98%.
  • Reported from earlier studies: chest wall seeding after VATS may occur in up to half of patients, compared with at most 22% after imaging-guided biopsy.
  • The review stated that patients treated with chemotherapy and/or radiotherapy rarely show dramatic improvement on imaging.
• The authors' conclusion: The authors concluded that radiologic studies play an important role in suggesting the diagnosis of malignant pleural mesothelioma, in choosing the biopsy site, in staging and in following response to therapy. They added that CT is usually used and that MR imaging may provide additional information in surgical candidates who have questionable areas of local tumor extension on CT.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Staging, Pleural Effusion, Chest X-Ray, Asbestos Exposure, Metastasis.

Related studies

• Imaging in pleural mesothelioma: A review of the 13th International Conference of the International Mesothelioma Interest Group — S.G. Armato, K.G. Blyth, et al. (2016)
• Imaging of thoracic occupational and environmental malignancies — K. Garg, D.A. Lynch (2002)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• New applications of magnetic resonance imaging for thoracic oncology — Y. Ohno (2014)
• 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)
• MR Imaging of Pleural Neoplasms — B.W. Carter, S.L. Betancourt, et al. (2018)

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