Diagnosis
➤ In surgical, thoracoscopic, or open pleural biopsies with sufficient
tissue, further subtyping and quantification of epithelial vs. sarcomatoid
components of mesothelioma may be undertaken. (Moderate
Recommendation; IC)
➤ The non-tissue based biomarkers that are under evaluation at this time
do not have the sensitivity or specificity to predict outcome or monitor
tumor response and are therefore NOT recommended. (Moderate
Recommendation; EB-I)
➤ While tumor genomic sequencing is currently done on a research basis in
mesothelioma and it may become clinically applicable in the near future,
it is NOT recommended at this time. (Moderate Recommendation; EB-I)
Staging
➤ A CT scan of the chest and upper abdomen with IV contrast is
recommended as the initial staging in patients with mesothelioma.
(Strong Recommendation; EB-I)
➤ An FDG PET/CT should usually be obtained for initial staging of patients
with mesothelioma. This may be omitted in patients who are not being
considered for definitive surgical resection. (Strong Recommendation;
EB-I)
➤ If abnormalities that suggest metastatic disease in the abdomen are
observed on a chest and upper abdomen CT or on a PET/CT then
consideration should be given to perform a dedicated abdominal
(+/- pelvic) CT scan, preferably with IV and oral contrast. (Strong
Recommendation; EB-I)
➤ An MRI (preferably with IV contrast) may be obtained to further assess
invasion of the tumor into the diaphragm, chest wall, mediastinum and
other areas. (Moderate Recommendation; EB-I)
➤ For patients being considered for maximal surgical cytoreduction,
a mediastinoscopy and/or endobronchial US should be considered
if enlarged and/or PET-avid mediastinal nodes are present. (Strong
Recommendation; EB-I)
➤ In the presence of contralateral pleural abnormalities detected on initial
PET/CT or chest CT scan, a contralateral thoracoscopy may be performed
to exclude contralateral disease. (Moderate Recommendation; EB-I)
➤ In patients with suspicious findings for intra-abdominal disease on imaging
and no other contraindications to surgery, it is strongly recommended that
a laparoscopy be performed. (Strong Recommendation; EB-I)
