Why Aren't Imaging Scans Always Effective in Determining Mesothelioma Surgery?

[MUSIC PLAYING] In our experience, scans are not very effective in understanding the extent of the disease. There are a number of reasons for that. One is that if you think about a layer of tissue, which is the pleura, and there's tumor on that pleura, what you're trying to understand is, has the disease gone across this very thin-- paper thin layer of tissue to go and invade into the chest wall? The CAT scan, even an MRI scan-- unable to show that unless there is a lot of disease. And that has to do with the accuracy of these scans. The second important point is that these scans, for example, a CAT scan, are based on taking, really, X-rays and computerize enhancements of these X-rays. That's what a CAT scan is. So when tissues are very close to each other, there's what's called volume averaging, which means that things go out of focus. So you really can't tell that slight difference. And that's really where the money is. Because if the disease has gone across through the pleura into the chest wall, on a microscopic level, that is metastatic. And that is advanced disease. What metastatic means is there are a lot of blood vessels on the other side. So when the disease goes across, it'll get into the blood vessels and then spread throughout the body. So even if you go and you take out the tumor and you feel good about that, you can see that that patient has disease elsewhere that is unrecognized. And our experience has shown that when you do this type of surgery, the results are not any different than not doing the surgery. And that's because that patient probably would have been served better with systemic therapy, like chemotherapy, et cetera, as opposed to very local therapy, which was what surgery is. So surgery should be reserved for localized disease. And we can talk a little bit about the types of disease forms that are localized or the types of mesothelioma patients who have localized disease who are good surgical candidates.