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Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

Anna C. Bibby, Selina Tsim, Nikolaos Kanellakis, Hannah Ball, Denis C. Talbot, Kevin G. Blyth, Nick A. Maskell, Ioannis Psallidas
European Respiratory Review 2016 25: 472-486; DOI: 10.1183/16000617.0063-2016
Anna C. Bibby
1Academic Respiratory Unit, University of Bristol, Bristol ,UK
2North Bristol NHS Trust, Bristol, UK
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  • For correspondence: Anna.Bibby@bristol.ac.uk
Selina Tsim
3Queen Elizabeth University Hospital, Glasgow, UK
4Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Nikolaos Kanellakis
5Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK
6Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
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Hannah Ball
6Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
7Dept of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Denis C. Talbot
7Dept of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Kevin G. Blyth
3Queen Elizabeth University Hospital, Glasgow, UK
8Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Nick A. Maskell
1Academic Respiratory Unit, University of Bristol, Bristol ,UK
2North Bristol NHS Trust, Bristol, UK
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Ioannis Psallidas
5Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK
6Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
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  • FIGURE 1
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    FIGURE 1

    Ultrasound demonstrating large echoic effusion (A) above a flattened diaphragm (B) with extensive thick, irregular nodularity arising from the diaphragm (C) and visceral pleural (D). This is highly suspicious for malignancy, most likely malignant pleural mesothelioma.

  • FIGURE 2
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    FIGURE 2

    FDG (18-fluoro-deoxy-glucose)-positron emission tomography showing malignant pleural mesothelioma. A: an area of high FDG uptake (maximum standardised uptake value of 13.4) in the left lateral pleura beneath the third rib. B: a right paratracheal lymph node with maximum standardised uptake value of 4.6.

  • FIGURE 3
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    FIGURE 3

    Flowchart demonstrating the decision making process for investigating and managing pleural effusions in malignant pleural mesothelioma. IPC: indwelling pleural catheter; CXR: chest radiograph.

  • FIGURE 4
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    FIGURE 4

    Talc poudrage seen at thoracoscopy. A: parietal pleura with ribs visible beneath and a fine layer of talc covering most of its surface. B: malignant-looking nodule on the parietal pleura. C: collapsed lung with talc covering its surface. D: talc collecting in the para-spinal gutter.

Tables

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  • TABLE 1

    The International Mesothelioma Interest Group Staging System for malignant pleural mesothelioma

    T
     T1Tumour of the ipsilateral parietal pleura, including diaphragm and mediastinal pleura
     T1aNo visceral pleural involvement
     T1bWith visceral pleural involvement
     T2Tumour affecting parietal, visceral, diaphragmatic and mediastinal pleura, with either involvement of diaphragmatic muscles or pulmonary parenchyma
     T3Involvement of the endothoracic fascia, extension into the mediastinal fat, non-transmural involvement of the pericardium or resectable focus of chest wall invasion
     T4Unresectable disease, diffuse chest wall or mediastinal involvement, direct transdiaphragmatic spread into the peritoneum, contralateral plural involvement, invasion of the spine, ribs or brachial plexus, trans-mural pericardial invasion or malignant pericardial effusion
    N
     N0No regional lymph node metastases
     N1Metastases in ipsilateral bronchopulmonary or hilar lymph nodes
     N2Metastases in subcarinal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary chain
     N3Contralateral lymph node metastases, ipsilateral or contralateral supraclavicular lymph node involvement, and scalene nodes
    M
     M0No extrathoracic metastases
     M1Extrathoracic metastases present
    • Reproduced from [41] with permission from the publisher.

Supplementary Materials

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  • Supplementary Material

    A.C. Bibby ERR-0063-2016_Bibby

    D.C. Talbot ERR-0063-2016_Talbot

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European Respiratory Review: 25 (142)
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Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment
Anna C. Bibby, Selina Tsim, Nikolaos Kanellakis, Hannah Ball, Denis C. Talbot, Kevin G. Blyth, Nick A. Maskell, Ioannis Psallidas
European Respiratory Review Dec 2016, 25 (142) 472-486; DOI: 10.1183/16000617.0063-2016

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Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment
Anna C. Bibby, Selina Tsim, Nikolaos Kanellakis, Hannah Ball, Denis C. Talbot, Kevin G. Blyth, Nick A. Maskell, Ioannis Psallidas
European Respiratory Review Dec 2016, 25 (142) 472-486; DOI: 10.1183/16000617.0063-2016
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