Table 1 Comparative staging systems for MPM: Butchart and ‘Brigham’ systems

I

Tumour confined within the ‘capsule’ of the parietal pleura, i.e. ipsilateral lung, pericardium

Disease completed resected within the capsule of the parietal pleura without adenopathy; ipsilateral pleura, lung, pericardium, diaphragm, or chest-wall disease limited to previous biopsy sites

II

Tumour invading chest wall or involving mediastinal structures, e.g. oesophagus, heart; intrathoracic nodal involvement

All of stage I with positive resection margins and/or intrapleural adenopathy

III

Tumour penetrating diaphragm to involve peritoneum directly, extrathoracic nodal involvement

Local extension of disease into chest wall or mediastinum, heart, or through diaphragm, peritoneum, or with extrapleural lymph node involvement

IV

Distant haematogenous metastases

Distant metastatic disease