Mesothelioma Update

By Mark Block, MD; and Alice M. Boylan, MD

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Radiographic Evaluation

The most common findings are a moderate to large unilateral pleural effusion or unilateral pleural thickening (nodular or smooth).⁶ Invasion of soft tissues and the chest wall with rib destruction may also be seen. Later in the course of disease, there may be volume loss with a shift of the mediastinum toward the side of the primary tumor, as well as lymphatic metastases. It is important to note that pleural plaques are often not visible (28% have plaques).⁵

MRI is preferred over CT by some for staging and preoperative evaluation because it is thought to better demonstrate the extent of disease and areas of invasion (Fig 1). However, one prospective trial failed to confirm the benefit of routine MRI vs CT for staging of mesothelioma.⁸

Fluorodeoxyglucose positron emission tomography shows promise as a tool to differentiate benign from malignant disease and as an adjunct for staging. In one study, it was found to be superior to CT for detecting lymph node involvement.⁹

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