Mesothelioma Diagnosis

Mesothelioma represents a fatal malignancy developing in the pleural and other serous cavities, linked to asbestos exposure. The combination of accurate medical history, physical examination, imaging studies and the acquisition of pathology is essential in the diagnosis of mesothelioma.

Direct exploration of the serous membranes (thoracoscopy for the pleural cavity and laparoscopy for the peritoneal cavity) is often a key step in the diagnostic process. In addition to facilitating the identification, multiple biopsies that are essential for correct diagnosis can be performed.

Image Credit: / Shutterstock
Image Credit: / Shutterstock

Imaging studies

Non-invasive imaging studies play an essential role in diagnosing and staging of patients with mesothelioma. Chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography have all been employed in evaluating the disease.

Initial detection of pleural mesothelioma usually stems from a radiographic chest examination. Primary radiographic signs include unilateral pleural abnormality with an associated pleural effusion, a shift of the mediastinum on that side and lung volume loss. Still, this technique does not provide a specific diagnosis; therefore a follow-up study with another imaging modality is usually indicated.

Intravenous contrast-enhanced CT currently represents the primary imaging modality for suspected pleural malignant disease. Mesothelioma is seen as a lobulated, circumferential soft tissue mass that often involves the interlobar fissures and the mediastinal pleura. On the other hand, CT findings of peritoneal mesothelioma are nonspecific and usually not sufficient to establish a proper diagnosis.

Magnetic resonance imaging adds significant information to the clinical evaluation of patients with pleural mesothelioma and can provide additional staging information, although it is not used routinely. The technique allows the acquisition of images in arbitrary planes, and the use of gadolinium enhancement can improve the identification of tumors that invaded the chest wall and the diaphragm.

PET provides different information than the other techniques due to the functional images of metabolic activity, thus in recent years, it has gained recognition for the assessment of mesothelioma. The use of this type of tomography improves the accuracy of diagnosing mediastinal nodal metastases, helps in staging and preoperative evaluation of mesothelioma, and it is also used as a guide to the optimal site for guided pleural biopsy.

Morphological diagnosis

Histologically, malignant mesothelioma can show epithelial morphology (50-70% of all cases), sarcomatoid morphology (7-20% of cases) or biphasic morphology, i.e. a combination of both (20-35% of cases). The experienced pathologist will recognize those tumors as mesothelial, although atypical histology can resemble a metastatic carcinoma.

Immunohistochemical staining has a central role in the diagnosis of mesothelioma. This diagnostic procedure looks for different proteins on the surface of the cells or inside them. It is often used to assess whether the malignancy in question is mesothelioma or lung cancer, which can sometimes appear to start in the inner lining of the chest.

Also, it is important to distinguish a malignant pleural process from an inflammatory process and immunohistochemistry has demonstrated immunoreactivity for keratin, p53 and epithelial membrane antigen (otherwise unusual for benign pleural disease) can be found in mesothelioma.

Immunohistochemistry is important in the differentiation of mesothelioma from other malignant diseases via markers such as mesothelin, cytokeratin 5, thrombomodulin and calretinin. The latter is the most commonly used antibody for detecting mesothelioma, with a reported sensitivity of 95% and specificity of 87%.

Last Updated: Apr 14, 2021

Dr. Tomislav Meštrović

Written by

Dr. Tomislav Meštrović

Dr. Tomislav Meštrović is a medical doctor (MD) with a Ph.D. in biomedical and health sciences, specialist in the field of clinical microbiology, and an Assistant Professor at Croatia's youngest university - University North. In addition to his interest in clinical, research and lecturing activities, his immense passion for medical writing and scientific communication goes back to his student days. He enjoys contributing back to the community. In his spare time, Tomislav is a movie buff and an avid traveler.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Meštrović, Tomislav. (2021, April 14). Mesothelioma Diagnosis. News-Medical. Retrieved on March 24, 2023 from

  • MLA

    Meštrović, Tomislav. "Mesothelioma Diagnosis". News-Medical. 24 March 2023. <>.

  • Chicago

    Meštrović, Tomislav. "Mesothelioma Diagnosis". News-Medical. (accessed March 24, 2023).

  • Harvard

    Meštrović, Tomislav. 2021. Mesothelioma Diagnosis. News-Medical, viewed 24 March 2023,


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment
You might also like...
CDC reports increase in mesothelioma deaths among women