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Summary of recommendations and good practice points
Section 3: Clinical features which predict the presence of mesothelioma
Do not rule out a diagnosis of malignant pleural mesothelioma (MPM) on the basis of symptoms and examination findings alone. Grade D.
Offer an urgent chest X-ray to patients with symptoms and signs as outlined in the National Institute for Health and Care Excellence (NICE) NG12. Grade D.
Refer all patients with a chest X-ray suggestive of MPM urgently (via the 2-week wait suspected cancer pathway in England and Wales). Consider referral for further investigation in patients with persistent symptoms and history of asbestos exposure despite normal chest X-ray. Grade D.
A thorough occupational history should be taken to cover all occupations throughout life. It is important to elicit para exposure by exploring details of relative and/or partner occupations. Grade D.
Section 4: Staging systems
Record staging of MPM according to the version 8 of the International Association for the Study of Lung Cancer (IASLC) staging proposals. Grade D.
Section 5: Imaging modalities for diagnosing and staging
Offer CT thorax with contrast (optimised for pleural evaluation) as the initial cross-sectional imaging modality in the evaluation of patients with suspected MPM. Grade D.
Use of positron emission tomography (PET)-CT for aiding diagnosis of MPM is not recommended in patients who have had prior talc pleurodesis and caution should be employed in populations with a high prevalence of TB. Grade D.
In patients where differentiating T stage will change management, consider MRI. Grade D.
In patients where excluding distant metastases will change management, offer PET-CT. Grade D.
Section 6: Pathological diagnosis
Immunohistochemistry (IHC) is recommended for the differential diagnosis of MPM in both biopsy and cytology-type specimens. Grade D.
A combination of at least two positive mesothelial (calretinin, cytokeratin 5/6, Wilms tumour 1, D-240) and at least two …
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