What diagnostic tests may be used in the diagnosis or staging of malignant pleural mesothelioma?
Chest radiography, CT, MRI, FDG PET, ultrasonography (US), thoracentesis, and biopsy are used in the diagnosis or staging of malignant pleural mesothelioma. Chest radiographs may sometimes appear normal, and negative pleural biopsy and cytology results do not exclude mesothelioma. US, CT, and FDG PET scanning may be used to guide biopsy, however, and increase diagnostic yield. CT and MRI are nearly equivalent in staging accuracy, although MRI is superior to CT for detection of diaphragmatic, endothoracic fascial, or focal chest wall invasion and is often used as a problem-solving tool after CT. FDG PET is also very useful for staging and preoperative evaluation and has increased accuracy for detecting malignant lymphadenopathy or occult extrathoracic metastases. Tumor metabolic activity on FDG PET and patient survival are inversely proportional.