Radiologist's guide to the ninth edition TNM staging system for quantitative and qualitative assessment of pleural mesothelioma Review


Authors: Murphy, D. J.; Nowak, A. K.; Frauenfelder, T.; Ginsberg, M. S.; Kodama, H.; de Rosen, V. L.; Mayoral, M.; Straus, C.; Benedetti, G.; Rusch, V. W.; Gill, R. R.
Review Title: Radiologist's guide to the ninth edition TNM staging system for quantitative and qualitative assessment of pleural mesothelioma
Abstract: <p>Pleural mesothelioma is a highly lethal, rare thoracic malignant neoplasm arising from mesothelial cells. Previous versions of the clinical TNM staging classification have relied on a qualitative radiologic assessment of tumor invasion. However, these qualitative assessments have not proved practical to implement, with poor interobserver agreement and lack of prognostic significance. The updated ninth edition of the International Association for the Study of Lung Cancer TNM staging system for pleural mesothelioma, jointly published by the American Joint Committee on Cancer and Union for International Cancer Control, proposes key evidence-based changes. The ninth edition incorporates quantitative measurements of pleural tumor and fissural thickness in the T descriptors for pleural mesothelioma and removes the qualitative descriptors that cannot be reliably detected on CT scans, such as endothoracic fascia, lung parenchymal invasion, and nontransmural diaphragm invasion or involvement. This article explains the rationale behind these changes and provides a practical guide to the ninth edition of the TNM staging system in clinical practice. (c) RSNA, 2025</p>
Keywords: extrapleural pneumonectomy; computed-tomography; lymph-node metastasis; international association; needle-aspiration; forthcoming 8th edition; project proposals; iaslc mesothelioma; nivolumab plus ipilimumab; lung-cancer mesothelioma
Journal Title: Radiology
Volume: 316
Issue: 3
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2025-09-01
Start Page: e250531
Language: English
ACCESSION: WOS:001574067800004
DOI: 10.1148/radiol.250531
PROVIDER: wos
PUBMED: 40956163
Notes: Review -- Source: Wos
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  1. Valerie W Rusch
    870 Rusch
  2. Michelle S Ginsberg
    240 Ginsberg