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Published on: December 21, 2019
Fatal pleural mesothelioma in Japan (2003-2008): evaluation of computed tomography findings
Katsuya Kato1,2, Kenichi Gemba3,4, Nobukazu Fujimoto3
1Department of Radiology, Okayama University Hospital, 2-1-1 Shikatacho, Okayama, 7008558, Japan. kato-rad@med.kawasaki-m.ac.jp.
Purpose:
The purpose of this study was to clarify the characteristic findings of mesothelioma at the time of diagnosis, and determine precautions and guidelines for diagnosing mesothelioma early in imaging studies.
Materials And Methods:
Overall, 327 patients with pleural mesothelioma were selected from 6030 patients who died of mesothelioma between 2003 and 2008 in Japan. Their imaging findings were examined retrospectively.
Results:
Plaques were found in 35 % of computed tomography (CT) scans. Asbestosis, diffuse pleural thickening, and rounded atelectasis were found in only seven (2 %), five (2 %), and two cases (1 %), respectively. Pleural thickening findings on CT scans were classified into four stages: no irregularity, mild irregularity, high irregularity, and mass formation. Overall, 18 % of cases did not show a clear irregularity. Localized thickening was observed in the mediastinal (77 %) and basal (76 %) pleura and in the interlobar fissure (49 %). Eight percent of cases did not have any thickening in these three areas.
Conclusions:
Upon examination of the CT scans at diagnosis, 18 % of mesothelioma cases did not show a clear irregularity. When diagnosing pleural effusion of unknown etiology, it is necessary to consider the possibility of mesothelioma even when no plaque and pleural irregularity are observed.
Insights
Early mesothelioma diagnosis is crucial. Even without clear imaging irregularities or plaques, consider mesothelioma in unknown pleural effusions.
Area of Science:
- Medical Imaging
- Oncology
- Pulmonology
Background:
- Mesothelioma diagnosis can be challenging.
- Characteristic imaging findings are key for early detection.
Purpose of the Study:
- To identify key imaging features of mesothelioma at diagnosis.
- To establish guidelines for early mesothelioma detection in imaging studies.
Main Methods:
- Retrospective analysis of 327 pleural mesothelioma patients' imaging findings.
- Data collected from patients who died of mesothelioma between 2003-2008 in Japan.
Main Results:
- Computed tomography (CT) scans showed plaques in 35% of cases.
- 18% of mesothelioma cases lacked clear pleural irregularity on CT scans.
- Localized thickening was common in mediastinal, basal pleura, and interlobar fissures.
Conclusions:
- Mesothelioma may present without typical plaques or irregularities.
- Consider mesothelioma in undiagnosed pleural effusions, even with subtle or absent imaging signs.
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