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Malignant Pleural Mesothelioma: Are There Imaging Characteristics Associated With Different Histologic Subtypes on Computed Tomography?

Escalon, Joanna G., MD; Harrington, Kate A., MB, BCh, BAO; Plodkowski, Andrew J., MD; Zheng, Junting, MS; Capanu, Marinela, PhD; Zauderer, Marjorie G., MD; Rusch, Valerie W., MD; Ginsberg, Michelle S., MD

Journal of Computer Assisted Tomography: July/August 2018 - Volume 42 - Issue 4 - p 601–606
doi: 10.1097/RCT.0000000000000727
Cardiothoracic Imaging

Objectives Determine imaging characteristics specific to epithelioid (eMPM), sarcomatoid (sMPM), and biphasic (bMPM) subtypes of malignant pleural mesothelioma (MPM) on computed tomography.

Methods Preoperative computed tomography scans of patients with MPM were retrospectively assessed for numerous features including primary affected side, volume loss, pleural thickness, pleural calcifications, pleural effusion, and lymphadenopathy.

Results One hundred twenty-five patients with MPM were included. Histologic subdivision was 97 eMPM (77%), 17 bMPM (14%), and 11 sMPM (9%). Nonepithelioid MPM (bMPM and sMPM) was more likely than eMPM to have calcified pleural plaques (P = 0.035). Analyzed separately, bMPM and sMPM each demonstrated calcified plaques more frequently than eMPM, and sMPM more often had internal mammary nodes; however, P values did not reach significance (P = 0.075 and 0.071, respectively).

Conclusions Calcified plaques are significantly more common in nonepithelioid subtypes compared with eMPM. Given the different prognoses and management of MPM subtypes, accurate noninvasive subtype classification is clinically vital.

From the Memorial Sloan Kettering Cancer Center, New York, NY.

Received for publication October 24, 2017; accepted January 8, 2018.

Correspondence to: Joanna G. Escalon, MD, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA (e-mail:

This study was supported in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. The funding source had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

All authors were partially supported by NIH/NCI Cancer Center Support Grant P30 CA008748. Marjorie G. Zauderer consulted for Astra Zeneca and Sellas Life Sciences and institution receives research funding from Verastem, MedImmune, Epizyme, Polaris, Sellas Life Sciences, and Bristol-Myers Squibb. Valerie W. Rusch is an unpaid member of the BMS Mesothelioma Scientific Advisory Board.

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