A Diagnostic Approach to Malignant Pleural Mesothelioma

Our plain-English summary of A Diagnostic Approach to Malignant Pleural Mesothelioma, by A. Aujayeb, P. Astoul (Pulmonary Therapy, 2025).

The study

• Authors: A. Aujayeb, P. Astoul
• Journal: Pulmonary Therapy
• Published: 2025;11(3):503-517
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In this concise article, we give a current overview of the practical approach to diagnosing pleural mesothelioma (PM). PM is a rare, incurable, aggressive cancer almost exclusively related to previous asbestos exposure. We begin by outlining the general approach to pleural malignancy. The focus then shifts to pleural mesothelioma (PM), with discussions on cytological analyses, a direct-to-thoracoscopy approach, specialist services, and future directions. This narrative review aims to provide an updated, practical overview of current and emerging diagnostic strategies.

© 2025. The Author(s).

In plain English

This article was a narrative review of how pleural mesothelioma is diagnosed. It was based on the expert opinion of two pleural physicians, in England and France. It did not study new patients and left out peritoneal mesothelioma and the overall cancer treatment landscape. The authors described pleural mesothelioma as almost exclusively linked with asbestos exposure. Citing a study, they reported that fluid testing (cytology) can detect pleural mesothelioma in less than 6% of cases, so a tissue biopsy is normally needed. They also cited a study that found negative fluid results very likely in people with asbestos exposure. From meta-analyses, they cited diagnostic yields of 84% for ultrasound-guided biopsy and 93% for CT-guided biopsy. Thoracoscopy, a camera inspection of the chest cavity done under local anaesthetic or surgically (VATS), often had yields above 95%. The authors' favoured approach was local anaesthetic thoracoscopy for all new patients. They also reviewed tissue markers such as BAP1 loss, specialist services, and newer tools including MRI, PET scans, mesothelin tests and breath tests. They said these newer tools warrant further research.

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 based on the authors' expert opinion; no new studies with human participants or animals
• Who was studied: No study population. The review covered published work on diagnosing pleural mesothelioma. Peritoneal mesothelioma and the overall oncological treatment landscape were left out of scope. The authors work in Northumbria (England) and Marseille (France).
• Exposure: Exposure was not studied. As background, the authors described pleural mesothelioma as almost exclusively linked with asbestos exposure. They listed chrysotile, actinolite, amosite, anthophyllite, crocidolite and tremolite as asbestos types, all carcinogenic.
• Main results:
  • Citing Arnold et al., the authors reported that the yield of pleural fluid cytology in patients with pleural mesothelioma can be less than 6%, so a tissue biopsy is normally required.
  • Citing Tsim et al., the authors reported that negative pleural fluid cytology is very likely in people with asbestos exposure. In those patients, local anaesthetic thoracoscopy should be the first diagnostic step.
  • Citing meta-analyses, the authors reported that ultrasound-guided biopsy has a diagnostic yield of 84%.
  • Citing the same meta-analyses, the authors reported a diagnostic yield of 93% for CT-guided biopsy.
  • The authors reported that local anaesthetic thoracoscopy (LAT) and video-assisted thoracoscopy (VATS) have similar diagnostic yields, often above 95%.
  • Citing guidance, the authors reported that LAT has less than 2% major complications. They cited a VATS complication rate approaching 10%.
  • The authors' favoured approach was LAT for all new patients. Patients with non-diagnostic biopsies, or who need additional procedures, would be referred for VATS.
  • A cited meta-analysis covered 1824 patients, 1016 of whom had pleural mesothelioma. For BAP1 loss, it reported a pooled sensitivity of 0.56 (95% CI 0.50 to 0.62) and a specificity of 1.00 (95% CI 0.95 to 1.00).
  • The cited work reported that using BAP1 loss and p16 deletion together gave a combined sensitivity of 0.76 (95% CI 0.62 to 0.88).
  • The authors described exhaled breath biomarker studies for pleural mesothelioma as still in early stages.
• The authors' conclusion: The authors concluded that the article gives an updated practical approach to diagnosing pleural mesothelioma, covering diagnostic methods, histopathology and service setup. They also concluded that several future developments warrant further research and evaluation.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Thoracoscopy.

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