Diagnostic et bilan du mésothéliome pleural malin

Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis and an increasing incidence. Despite recent improvements in the management, most MPM patients are diagnosed late in the course of the disease. To obtain an earlier diagnosis of MPM represents an important goal for clinicians that could increase the survival of patients. To this date, a firm and reliable diagnosis of mesothelioma is based on histology, usually obtained by thoracoscopy, the key diagnostic procedure for MPM. Many blood or pleural fluid markers, including soluble mesothelin and osteopontin, have been proposed for the diagnosis but none has yet been validated. Soluble mesothelin (SMRP), the most promising candidate, has a relatively good diagnostic value but it is specific for the most frequent subtype (epithelioid) of mesothelioma, thus limiting its utility in practice. Other potential markers such as osteopontin are of little interest for the diagnosis of MPM because of their low specificity. Imaging procedures such as CT scanning and positron emission tomography (18F-PET), separately, or better when coupled together, may help in both diagnosis and staging. The current international TNM classification is of limited use for staging MPM in routine practice because it is based on CT scanning and has been validated only in surgically treated patients, a very small minority of cases. The management of MPM has been better defined by the guidelines from the Experts'Conference of the Société de Pneumologie de Langue Française in 2005, up-dated last year by the European Respiratory Society taskforce.