Accurate Diagnosis of Pleural Mesothelioma with History and Imaging Only

Medical history and CT imaging may be enough to make an accurate diagnosis of pleural mesothelioma, even without a biopsy.

That finding comes from a team of French and Canadian researchers led by Universite Laval in Quebec. 

Biopsy is usually considered critical for accurate diagnosis of pleural mesothelioma. But the French and Canadian team says imaging studies may provide enough information to make a diagnosis. 

This could be especially good news for people who are not healthy enough to undergo thoracoscopy.

Pleural Mesothelioma Diagnostic Procedure: First Steps

Pleural mesothelioma is the most common type of mesothelioma. Mesothelioma is an aggressive cancer that grows on the membranes around internal organs. 

This cancer is rare and notoriously difficult to diagnose, especially in its early stages. To make an accurate diagnosis of pleural mesothelioma, doctors typically follow several steps. 

When a patient comes in with mesothelioma symptoms, the first step is a physical exam and a thorough medical history. Doctors need to know if the patient has ever been exposed to asbestos, the main cause of malignant mesothelioma.

Mesothelioma and some other types of cancer cause excess fluid around the lungs. This is called malignant pleural effusion (MPE). Pathologists study cells from this fluid to help with the accurate diagnosis of pleural mesothelioma. 

CT Imaging Can Support Accurate Diagnosis of Pleural Mesothelioma

Most suspected mesothelioma patients also undergo imaging studies. X-rays and CT scans can give doctors important information about the state of the pleural lining.

If the signs point to mesothelioma, the patient is referred for thoracoscopy. During thoracoscopy, doctors use a small fiber optic camera to examine the inside of the chest. They can also use it to guide them in removing a small amount of tumor tissue. 

Biopsy is the gold standard for making an accurate diagnosis of pleural mesothelioma. 

“But not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only,” writes study author Marie-Chantal Fortin.

The goal of the new study was to determine whether this can still lead to accurate diagnosis of pleural mesothelioma. 

A Qualified ‘Yes’ to CT and History Only

The French and Canadian researchers examined the medical charts and imaging studies of 92 patients with malignant pleural effusion. 

They found that people with a certain amount of pleural thickening all the way around were most likely to be diagnosed with mesothelioma. 

“Only asbestos exposure and circumferential pleural thickening were significantly associated with a diagnosis of malignant pleural mesothelioma,” concludes the study.

Pleural biopsy is still the best way to ensure an accurate diagnosis of pleural mesothelioma. But in cases where that is not possible, the researchers say CT scans and asbestos history may be enough.

Source:

Fortin, M, et al, “Diagnostic Value of Computed Tomography Imaging Features in Malignant Pleural Mesothelioma”, October 25, 2019, Respiration, Epub ahead of print, https://www.karger.com/Article/Abstract/503239