Advances in mesothelioma imaging and implications for surgical management

In malignant pleural mesothelioma (MPM), surgery may be offered for diagnostic or palliative purposes, or in selected patients as part of a multi-modality radical treatment strategy. Imaging results are routinely used to select patients for surgery in these settings. However, the initially subtle morphology and subsequent rind-like growth pattern of the primary tumour combined with complex pleural space geometry and unfamiliar nodal drainage to present major challenges in this regard. In this article, we summarize recent imaging developments that allow clinicians to make better diagnostic, staging and perioperative decisions in MPM. We also discuss the challenges involved in selecting patients for palliative MPM surgery, particularly those with non-expansile (or trapped) lung.