TY - JOUR T1 - British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma JF - Thorax JO - Thorax SP - i1 LP - i30 DO - 10.1136/thoraxjnl-2017-211321 VL - 73 IS - Suppl 1 AU - Ian Woolhouse AU - Lesley Bishop AU - Liz Darlison AU - Duneesha De Fonseka AU - Anthony Edey AU - John Edwards AU - Corinne Faivre-Finn AU - Dean A Fennell AU - Steve Holmes AU - Keith M Kerr AU - Apostolos Nakas AU - Tim Peel AU - Najib M Rahman AU - Mark Slade AU - Jeremy Steele AU - Selina Tsim AU - Nick A Maskell Y1 - 2018/03/01 UR - http://thorax.bmj.com/content/73/Suppl_1/i1.abstract N2 - Section 3: Clinical features which predict the presence of mesotheliomaRecommendationsDo 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 systemsRecommendationRecord 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 stagingRecommendationsOffer 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 diagnosisRecommendationsImmunohistochemistry (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 … ER -