New Era for Malignant Pleural Mesothelioma

Updates on Therapeutic Options

Anne S. Tsao, MD, MBA; Harvey I. Pass, MD; Andreas Rimner, MD; Aaron S. Mansfield, MD


J Clin Oncol. 2022;40(6):681-692. 

In This Article

Radiology Technology

Imaging suggestive of pleural mesothelioma must always be accompanied by histologic confirmation of the diagnosis. Computed tomography (CT) is presently the standard of care for the diagnosis and monitoring of treatment outcomes in pleural mesothelioma.[19,20] Pleural changes on CT include pleural plaques, diffuse pleural thickening, and pleural effusion. The lobulated pleural encasement of the lung frequently causes lower-lobe collapse.[21,22] Computerized tomography, however, has not proven to be useful for mesothelioma screening in high-risk asbestos-exposed populations.[23] Volumetric analysis as well as other linear approaches for estimating the bulk of disease demonstrated correlations with the prognosis of patients with the disease.[24]

Metabolic imaging with 18F-labeled fluorodeoxyglucose-positron emission tomography-CT is also crucial in defining the extent of disease, especially in individuals who are being considered for resection.[25] Upward of 10% of patients having preoperative staging for possible mesothelioma resection are found to have extrathoracic disease.[26] Magnetic resonance imaging (MRI) with gadolinium enhancement has always been useful for investigation of chest wall and diaphragmatic invasion.[27] Recently, there has been interest in the use of diffusion-weighted MRI to further classify benign from malignant pleural diseases as well as histology of mesothelioma;[28,29] however, further studies have not validated MRI histologic differentiation of mesothelioma. A variety of novel radiomic algorithms for further image classification of pleural mesothelioma are under investigation,[30–32] with the goal of defining growth of the disease, but these studies are not currently mature.