Background/Objectives: Malignant pleural mesothelioma (MPM) is a rare, aggressive tumor with a poor prognosis and complex diagnostic pathways. Pulmonologists often play a central role in its initial recognition and investigation. This narrative review synthesizes the current evidence on the diagnostic approach to MPM, with emphasis on imaging, tissue sampling, histopathology, and emerging diagnostic innovations relevant to clinical pulmonology.Methods: English-language studies published between January 2005 and June 2025 were identified from PubMed and Scopus. International guidelines and consensus documents were also reviewed to provide an updated overview of diagnostic strategies.Results: Diagnosis of MPM relies on a stepwise integration of clinical, radiological, and pathological information. Thoracic ultrasound, computed tomography, positron emission computed tomography and magnetic resonance imaging complement each other across different stages of the diagnostic pathway. Image-guided pleural biopsy and medical thoracoscopy remain the gold standard for tissue confirmation, supported by immunohistochemistry and molecular testing. The 2021 World Health Organization classification of pleural tumors and the International Association Study of Lung Cancer 9th Edition Tumour-Node-Mestastatis system have refined histologic and staging criteria, thereby improving reproducibility and prognostic accuracy. Emerging tools, including liquid biopsy, novel serum and molecular biomarkers, artificial-intelligence-based radiomics, and breathomics, offer promise for earlier and less invasive diagnosis but require prospective validation.Conclusions: Current advances are redefining MPM diagnosis toward integrated, multidisciplinary, and precision-based models. Future priorities include standardizing diagnostic algorithms, validating minimally invasive biomarkers, and integrating AI and molecular profiling into clinical workflows to enhance patient stratification.
背景/目的：恶性胸膜间皮瘤（MPM）是一种罕见、侵袭性强、预后不良且诊断路径复杂的肿瘤。呼吸科医师常在其早期识别与检查中发挥核心作用。本文通过叙述性综述，整合了当前关于MPM诊断方法的证据，重点阐述影像学检查、组织取样、组织病理学以及与临床呼吸病学相关的新兴诊断技术。 方法：通过PubMed和Scopus数据库检索2005年1月至2025年6月期间发表的英文研究。同时回顾了国际指南和共识文件，以提供诊断策略的最新概述。 结果：MPM的诊断依赖于临床、影像学和病理学信息的逐步整合。胸部超声、计算机断层扫描、正电子发射计算机断层扫描和磁共振成像在诊断路径的不同阶段相互补充。影像引导下胸膜活检和内科胸腔镜检查仍是组织确诊的金标准，并得到免疫组织化学和分子检测的支持。2021年世界卫生组织胸膜肿瘤分类及国际肺癌研究协会第九版TNM分期系统完善了组织学和分期标准，从而提高了诊断的可重复性和预后判断的准确性。新兴工具，包括液体活检、新型血清和分子生物标志物、基于人工智能的影像组学以及呼气组学，为更早期、微创的诊断提供了可能，但尚需前瞻性验证。 结论：当前进展正将MPM的诊断重新定义为整合性、多学科和基于精准医学的模式。未来的重点包括标准化诊断流程、验证微创生物标志物，以及将人工智能和分子谱分析整合到临床工作流程中，以优化患者分层。
Pleural Mesothelioma Diagnosis for the Pulmonologist: Steps Along the Way
肿瘤(癌症)患者之家