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Last Updated: 03/07/2024
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The Role of X-Ray in Mesothelioma Diagnosis

X-ray imaging is an important part of a pleural mesothelioma diagnosis. A chest X-ray is one of the most common initial tests for anyone experiencing difficulty breathing, chronic cough or other symptoms affecting the lungs. A mesothelioma chest X-ray can provide important information needed for diagnosis and treatment of the disease, which can include chemotherapy, immunotherapy or  surgery.

As with lung cancer, guidelines recommend an urgent chest X-ray for anyone with signs and symptoms of pleural mesothelioma. Chest X-rays are also useful for monitoring people at high risk of mesothelioma and other asbestos-related diseases. Having regular chest X-rays can detect changes over time, making it extremely useful for finding early signs of disease.

Key Facts About X-Rays:
  • Allow doctors to monitor people with high asbestos exposure for lung disease.
  • Commonly used to look for mesothelioma.
  • Detect changes in the pleural lining that can indicate mesothelioma.
  • Imaging alone cannot definitively diagnose mesothelioma.

X-ray imaging has some limitations when it comes to diagnosing mesothelioma. A tumor biopsy is necessary for a definitive diagnosis. However, mesothelioma imaging scans play an important role in finding tumors and determining the stage of the disease.

Mesothelioma Staging With X-Rays

Mesothelioma X-ray imaging has limited usefulness for staging the cancer. Mesothelioma staging is based on the size, number and location of tumors as well as whether lymph nodes are involved or metastatic tumors are present. 

X-rays can show pleural effusions, tumors and other findings around the lungs. However, they cannot always help identify very small tumors. Abnormalities in and around the lungs — such as interstitial lung disease and pleural plaques caused by asbestos — can obscure parts of the chest, making it difficult to clearly see the anatomy.

Computer-based three-dimensional imaging is necessary to identify small tumors and see details outside the lungs. Computed tomography scans are typically used for mesothelioma staging because they can create 3D images of the entire body viewable in cross-section. This allows doctors to find tumors, fluid buildup and other abnormalities throughout the body. In addition to CT scans, the results of magnetic resonance imaging and positron emission tomography scans can help stage mesothelioma.

Mesothelioma X-Ray Findings

Mesothelioma commonly causes several abnormalities that doctors can identify in an X-ray. However, these findings are nonspecific, meaning that other conditions — such as lung cancer — can appear the same on an X-ray image. Mesothelioma X-ray findings can include a collapsed lung, pleural effusion (fluid around the lungs), pleural thickening, masses (tumors) in the lungs and pleura, pleural plaques and obstructions such as a tumor blocking an airway.

My arms went numb. I burned myself with an iron and didn’t feel it. I found it more and more difficult to breathe. I was sent for an X-ray and they saw the fluid [around] my left lung.
Mavis N.
pleural mesothelioma survivor

Abnormalities on an X-ray, such as fluid around the lung, are a clue that indicates possible mesothelioma or other cancer. This prompts doctors to perform further testing to determine the cause of the abnormality. According to Mavis N., after finding fluid around her lung in a chest X-ray, “They rushed me into hospital and drained the fluid and tested it.” Ultimately, this led to a diagnosis of pleural mesothelioma.

Sometimes doctors find mesothelioma and other tumors during a routine X-ray or an X-ray taken for another purpose. After falling from a tree, mesothelioma survivor Barry Knowles had a chest X-ray. In addition to several cracked ribs, the images showed an “ominous shadow” that doctors later diagnosed as mesothelioma.

Emerging Technologies in Mesothelioma X-Rays

Exciting new advances in X-ray technology are being used to improve cancer diagnosis and develop new mesothelioma treatments. This includes new X-ray techniques such as X-ray dark-field radiography as well as photodynamic therapy. 

X-ray dark-field radiography is a new imaging technique that uses less radiation than traditional X-rays while providing greater detail. It is being evaluated for use in the diagnosis of a variety of lung diseases. 

PDT uses light to activate compounds injected into the body, causing them to release reactive oxygen species that can destroy cancer cells. A specific wavelength of light focused on a single spot in the body targets cancer cells. X-PDT is a new technique that uses X-rays in a similar way. Unlike light, X-rays can penetrate the entire body, allowing doctors to treat tumors deep within the body. Recent developments using low-dose X-rays can target cancer cells while sparing healthy tissue and avoiding exposure to excessive radiation.

Frequently Asked Questions (FAQs)

Can X-rays distinguish between different types of mesothelioma?

No, X-rays can identify tumors and other abnormalities, but they can’t determine the cell type of a tumor or where it originated. Both pleural mesothelioma and pericardial mesothelioma occur primarily in the chest, but peritoneal mesothelioma can also metastasize to the chest. Likewise, pleural mesothelioma can cause tumors in the peritoneum. A biopsy is necessary to identify the cell type and diagnose mesothelioma.

Are mesothelioma X-rays the only imaging technique used for diagnosis?

No. Other types of imaging, including ultrasound, CT, MRI and PET scans, are also used to diagnose mesothelioma. Each type of scan has different strengths and limitations, making them useful for different purposes. For example, CT scans are commonly used in mesothelioma staging, while X-rays are less useful for staging.

What are the limitations of X-rays in detecting mesothelioma?

X-ray images only provide a two-dimensional image with limited detail. Because of this, other abnormalities may obscure some X-ray findings. Other types of scans for mesothelioma can provide greater detail. Computer-assisted scans, such as CT, MRI and PET scans, can produce very detailed 3D images of the body. These scans can also capture images of the entire body at one time, unlike X-rays, which are limited to one area of the body at a time.

How do mesothelioma X-ray findings influence treatment options?

Mesothelioma chest X-rays can help guide treatment to a certain extent. Chest X-rays can identify the location of tumors, obstructions and other abnormalities in the lungs. This can indicate whether a patient needs a chest tube to drain fluid around the lungs and which structures in the lungs mesothelioma is affecting.

Factors such as the presence of pleural effusion, location of tumors and other changes in the lungs help determine which mesothelioma treatment options are best for an individual patient. However, the mesothelioma stage, pathology testing from tumor biopsies and the patient’s overall health are the main factors that help determine the best treatment option.

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