New Updates of the Imaging Role in Diagnosis, Staging, and Response Treatment of Malignant Pleural Mesothelioma

Our plain-English summary of New Updates of the Imaging Role in Diagnosis, Staging, and Response Treatment of Malignant Pleural Mesothelioma, by C. Romei, S.C. Fanni, F. Volpi, et al (Cancers, 2021).

The study

• Authors: C. Romei, S.C. Fanni, F. Volpi, A. Milazzo, C.A. D'Amore, L. Colligiani, E. Neri, A. De Liperi, G.M. Stella, C. Bortolotto
• Journal: Cancers
• Published: 2021;13(17)
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. CT is the first imaging technique used for diagnosis, staging, and assessment of therapy response. Although, CT has intrinsic limitations due to low soft tissue contrast and the current staging system as well as criteria for evaluating response, it does not consider the complex growth pattern of this tumor. Computer-based methods have proven their potentiality in diagnosis, staging, prognosis, and assessment of therapy response; moreover, computer-based methods can make feasible tasks like segmentation that would otherwise be impracticable. MRI, thanks to its high soft tissue contrast evaluation of contrast enhancement and through diffusion-weighted-images, could replace CT in many clinical settings.

In plain English

This article was a systematic review, not a new study of patients. The authors searched Scopus, Web of Science, Cochrane, Google Scholar and PubMed, last on February 10, 2021. They looked for English-language original research on imaging of malignant pleural mesothelioma, focusing on computer-based methods applied to CT scans (such as automated tumor outlining and radiomics) and on MRI. From 4079 records, 45 studies were included and described. The review did not examine asbestos exposure. Among the reviewed studies, one of 472 surgical patients reported that a staging model using CT tumor volume and fissure thickness classified prognosis better than standard clinical staging. Several reviewed studies reported that MRI showed chest wall and diaphragm involvement better than CT, although one found no statistically significant difference between CT and MRI for overall staging. The authors concluded that CT remains the primary imaging method and that MRI and computer-based methods have the potential to overcome its limits, but that larger prospective studies are needed. They noted that many reviewed studies were small and included patients already known to have pleural lesions.

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: systematic literature review with narrative synthesis
• Who was studied: 45 published original research studies in English, up to 10 February 2021, on imaging of malignant pleural mesothelioma, selected from 4079 records found in five databases
• Exposure: Not an exposure study. The review covered imaging techniques: computer-based analysis of CT scans and MRI. Asbestos exposure is mentioned only in the introduction as a risk factor for malignant pleural mesothelioma.
• Main results:
  • 45 studies were included in the review.
  • In a reviewed study by Gill et al. (2018) of 472 patients who had surgery, standard clinical AJCC staging showed a c-index of 0.562. A model using CT tumor volume plus maximal fissure thickness reached a c-index of 0.638 (p = 0.001).
  • In a reviewed study by Liu et al. (2010) of 30 patients, change in CT tumor volume was associated with overall survival (HR 1.94, p = 0.04). mRECIST measurements did not predict overall survival (HR 1.06, p = 0.25).
  • In a reviewed study by Tsim et al. (2018) of 60 patients, MRI early contrast enhancement showed a sensitivity of 83% and a negative predictive value of 92% for pleural malignancy.
  • In a reviewed study by Hierholzer et al. (2000), MRI was more sensitive than CT for chest wall and diaphragm involvement.
  • In a reviewed study by Heelan et al. (1999), no statistically significant differences were found between CT and MRI for overall staging of malignant pleural mesothelioma.
• The authors' conclusion: The authors concluded that CT is still the primary imaging method for malignant pleural mesothelioma. In their view, MRI and computer-based methods have the potential to overcome CT's limits, but new prospective studies with larger groups of patients are needed before these techniques can be used in clinical practice.
• Limitations the authors state:
  • Because malignant pleural mesothelioma is rare, the reviewed studies often had small patient groups, so their results may not be generalizable.
  • Most reviewed studies included patients with already known pleural lesions, which biased estimates of accuracy and sensitivity.
  • Datasets and algorithms in the computer-based studies were often not public, making results hard to reproduce or compare.
  • For Google Scholar, only the first 200 results of each search were considered.

Topics

Medical terms in this study, explained in our Lexicon: Staging, Pleural Mesothelioma, Neoplasm, Prognosis.

Related studies

• The Use of Chest Magnetic Resonance Imaging in Malignant Pleural Mesothelioma Diagnosis — F. Volpi, C.A. D'Amore, et al. (2022)
• Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment — A.C. Bibby, S. Tsim, et al. (2016)
• Malignant pleural mesothelioma: an update on diagnosis and treatment options — S. Kondola, D. Manners, et al. (2016)
• Updates in the diagnosis and treatment of malignant pleural mesothelioma — D. Katzman, D.H. Sterman (2018)
• Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update — C. Cao, S.K. Krog Andvik, et al. (2011)
• What's new in neoplastic pulmonary pathology 2026: updates on grading, staging and molecular testing — A. Tiefenbacher, L. Brčić (2026)

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