Key Takeaways: MPM is usually diagnosed through a biopsy, or a small sample of living tissue
of the pleural mesothelium, which is the tissue surrounding the lungs. However, some
manifestations of MPM elude traditional diagnostic measures. Diagnosing malignant pleural mesothelioma can be difficult. There are new subgroups of MPM manifestation that have been identified by algorithms; in the future, incorrect diagnoses might be mitigated by AI-assisted diagnostics.
Traditional Diagnostic Measures For Diagnosing Malignant Pleural Mesothelioma
- The patient usually presents with symptoms local to the chest and/or lungs. These
symptoms can include a persistent cough, general pain in the chest area, fatigue, and
difficulty breathing. - To rule out other diagnoses, providers will first gather a patient’s medical and
occupational history. If the patient has suffered occupational exposure to asbestos, then
the following processes of imaging and histological samples might be expedited. - An X-Ray of the chest might be ordered. This will visualize possible calcium build-ups
on the pleural tissues, whether there might be an excess of fluid between the lungs and
the spaces outside/between them, or a thickening of the pleural tissues. - Next, a CT (computed tomography) will likely be conducted. These scans use radiation,
much like X-Rays, but can visualize soft tissues and organs much clearer through
cross-sectional “slices” of the body. - Next, a doctor might order blood tests, as patients with mesothelioma often have elevated
levels of certain biological substances. These are called biomarkers. - Lastly, to ensure the correct diagnosis of MPM (rather than lung cancer, pneumonia, a
different cancer altogether, etc.), doctors will often take a biopsy, which is a small sample
of living tissue extracted from the affected area. Scientists will then take this sample and
compare it to previous mesothelioma manifestations; this is an excellent clinical strategy
that is largely successful for diagnosis.
Exceptions to Traditional Diagnostic Methods
While most patients with mesothelioma are diagnosed in the sequence of the aforementioned,
some patients escape proper diagnosis: “…a significant rate of MPM show a wide spectrum of
clinical manifestations, unusual radiologic and morphologic appearances, aberrant or “null”
phenotype at immunohistochemistry, or even combinations of all these features [9],” (Rossi, et.
al).
Even when biopsies are performed, MPM often presents as heterogeneous, meaning that
depending on the location within the tumor that the biopsy is performed, there are different
genetic and phenotypic (physical) presentations of cells. This presents a significant barrier to
correct diagnosis.
Recently, an algorithm (MesoNet) was trained to identify the different heterogeneous
manifestations of MPM cells: “This deep learning algorithm highlighted the great heterogeneity
of various parts of MPM. Based on this artificial intelligence approach, expert thoracic
pathologists proposed another morphologic subtype of MPM more recently, namely transitional
histology, in the attempt to identify a subgroup of MPM with dismal prognosis and challenging
morphology between epithelioid and sarcomatoid feature [116],” (Rossi et. al). This has exciting
implications for future MPM diagnostic techniques: as supplemented with AI, doctors will
hopefully be able to accurately diagnose MPM in less time. This might also contribute to an
increased prognosis–if MPM is detected earlier and with more accuracy, then it can be addressed
much sooner.
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Sources:
How Is Malignant Mesothelioma Diagnosed? (n.d.). Retrieved January 25, 2024, from
https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-stagi
ng/how-diagnosed.html
Rossi, G., Davoli, F., Poletti, V., Cavazza, A., & Lococo, F. (2021). When the Diagnosis of
Mesothelioma Challenges Textbooks and Guidelines. Journal of Clinical Medicine,
10(11), Article 11. https://doi.org/10.3390/jcm1011243
