Advances in diagnosis and management of pleural mesothelioma: the Danish clinical guidelines

Our plain-English summary of Advances in diagnosis and management of pleural mesothelioma: the Danish clinical guidelines, by V. Panou, J.B. Sørensen, J. Ravn, et al (European Clinical Respiratory Journal, 2025).

The study

• Authors: V. Panou, J.B. Sørensen, J. Ravn, E. Santoni-Rugiu
• Journal: European Clinical Respiratory Journal
• Published: 2025;12(1):2580795
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma (PM) is a rare, aggressive malignancy of the pleura. The PM diagnosis is challenging, both in terms of imaging, sampling of representative biopsies and pathological examination, and the treatment options are limited. The main aim of this article is to summarize the most recent advances in the diagnosis and management of PM as presented in the Danish clinical guidelines for PM. An expert task force consisting of a lung physician, a pathologist, an oncologist, and a thoracic surgeon conducted an ad hoc literature search during November 2023-July 2024, reviewed the evidence and developed the current clinical guidelines after reaching consensus. The article appraises the radiological modalities and biopsy techniques that are employed in PM diagnostics, provides a comprehensive overview of the evidence behind the PM histopathological and cytological diagnosis, and asserts the state of the art and novel developments of oncological, multimodal, and palliative PM treatment and follow-up that are portrayed in the Danish clinical guidelines.

© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

In plain English

This article is a review presenting the Danish national clinical guidelines for pleural mesothelioma. It did not study patients directly. A task force of a lung physician, a pathologist, an oncologist and a thoracic surgeon, appointed by the Danish Lung Cancer Group, searched the literature ad hoc between November 2023 and July 2024 and agreed on recommendations by consensus. The guidelines give contrast CT of the chest and upper abdomen a central role in diagnosis and describe thoracoscopic pleural biopsies as often the procedure of choice. They recommend that every first diagnosis be confirmed by experienced mesothelioma pathologists and that asbestos exposure be evaluated by occupational physicians. The authors noted that in Denmark only cases with occupational and, to a lesser extent, domestic asbestos exposure are entitled to compensation. The authors concluded that platinum plus pemetrexed remains the most widely used first-line chemotherapy. In Denmark, nivolumab plus ipilimumab is preferred for unresectable non-epithelioid disease. On average, 25 of about 140 yearly Danish cases are operated on. The authors noted that their literature search had no shared strategy.

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: Review article presenting national clinical guidelines developed by expert consensus after an ad hoc literature search
• Who was studied: No patients were studied. A four-member expert task force (a lung physician, a pathologist, an oncologist and a thoracic surgeon) appointed by the Danish Lung Cancer Group reviewed the literature on pleural mesothelioma between November 2023 and July 2024 to update the Danish guidelines.
• Exposure: Not an exposure study. The article describes asbestos exposure as the main cause of pleural mesothelioma and recommends that exposure be evaluated by occupational physicians. It states that occupational, domestic and environmental asbestos exposure may all cause the disease.
• Main results:
  • The guidelines give CT of the thorax and upper abdomen a central role in the diagnostic workup for pleural mesothelioma.
  • Thoracoscopic pleural biopsies are described as often the procedure of choice for diagnosis. Closed pleural biopsies using Abram's or Cope's needle are not recommended.
  • All initial pleural mesothelioma diagnoses should be confirmed by experienced mesothelioma pathologists. Deep invasion into the pleural stroma and subpleural fat is described as an essential diagnostic criterion.
  • In Denmark, only cases with previous occupational and, to a lesser extent, domestic asbestos exposure are entitled to compensation.
  • Nivolumab plus ipilimumab is the preferred first-line treatment in Denmark for unresectable patients with non-epithelioid histology. The article cites the CheckMate-743 trial (another study), which reported median overall survival of 18.1 vs. 8.8 months for nivolumab plus ipilimumab vs. chemotherapy in non-epithelioid histology, and 18.7 vs. 16.5 months in epithelioid histology.
  • Surgery with platinum-pemetrexed chemotherapy can be used as curative-intended treatment in selected patients. Selection criteria include age below 75 years, performance status 0 to 1, tumor stage I to IIIA, and epithelioid or biphasic histology with less than 50% sarcomatoid component. On average, 25 of approximately 140 yearly Danish cases are operated on at Rigshospitalet.
  • After curative multimodal treatment, CT of the thorax is recommended every three to six months.
• The authors' conclusion: The authors concluded that platinum together with pemetrexed remains the most widely used and best documented first-line chemotherapy for unresectable pleural mesothelioma. They also concluded that nivolumab plus ipilimumab has greatly improved results for non-epithelioid subtypes and appears equal to chemotherapy in the epithelioid subtype.
• Limitations the authors state:
  • The literature search was conducted ad hoc, with no shared (mutual) search strategy among the task force members.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Biopsy, State-of-the-Art Defense, Palliative Care.

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