An update on pleuro-pulmonary cytopathology: Part i: Cytological diagnosis of mesothelioma and molecular cytology of lung cancer with an historical perspective

Our plain-English summary of An update on pleuro-pulmonary cytopathology: Part i: Cytological diagnosis of mesothelioma and molecular cytology of lung cancer with an historical perspective, by C.W. Bedrossian (Diagnostic Cytopathology, 2015).

The study

• Author: C.W. Bedrossian
• Journal: Diagnostic Cytopathology
• Published: 2015;43(7):513-26
• Type of article: Editorial, Historical article, Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was an editorial, not an original study, and reported no new patient data. The author reviewed about 100 years of pleuro-pulmonary cytopathology (the study of cells from the lungs and pleura). The author argued that malignant mesothelioma can be diagnosed from cells, mainly in pleural fluid. The editorial named asbestos as the main cause of malignant mesothelioma, and tobacco of lung cancer. Citing other work, the author noted data from over 6,000 thoracenteses (procedures that draw chest fluid). In those data, effusion cytology combined with immunocytochemistry gave a positive predictive value of 99%. Others had cautioned that this center had special mesothelioma expertise and treated mainly asbestos-exposed miners. The author also cited a survey in which 66% of U.S. hospital cytology laboratories issued mesothelioma diagnoses when warranted. Other cited reports found that sensitivity rose from 53.3% with one fluid specimen to 73.3% with three. The author believed neither a cytology-only nor a tissue-only diagnosis should be made without immunohistochemical marker panels. The author foresaw a time when demands for biopsy confirmation of a properly conducted cytological diagnosis would end.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial (narrative, historical review of the literature); no original data collected
• Who was studied: No patients or subjects studied; the editorial reviewed published developments in pleuro-pulmonary cytopathology over roughly the past 100 years
• Exposure: Not an exposure study. The editorial described asbestos as the main etiological agent for malignant mesothelioma and tobacco for lung cancer.
• Main results:
  • The author stated that cytological examination of pleural fluid had emerged as the first-line laboratory test in a patient with pleural effusion and suspected malignant mesothelioma.
  • Citing another study (Segal et al.), the author reported data from over 6,000 thoracentesis procedures. In those data, effusion cytology used in conjunction with immunocytochemistry gave virtually no false positive diagnoses of malignant mesothelioma and a positive predictive value of 99%. This is not this editorial's own finding.
  • The author noted that others had viewed the applicability of that center's methodology with caution. The reason given was that the center had special expertise in managing malignant mesothelioma and treated mainly asbestos exposed miners. The author replied that experience with the disease and clinical information are always advisable.
  • Citing a survey of U.S. hospitals, the author reported that 66% of their cytology laboratories issue a diagnosis of malignant mesothelioma if warranted. This is not this editorial's own finding.
  • Citing other studies, the author reported a diagnostic yield of pleural fluid cytology averaging 58% for malignant mesothelioma. These are not this editorial's own findings.
  • Citing another study, the author reported that sensitivity improved with repeated thoracenteses: from 53.3% with one specimen, to 66.7% with two specimens, and 73.3% with three specimens.
  • The author stated a belief that neither a cytology-only nor a histopathology-only diagnosis of malignant mesothelioma should be attempted without, at a minimum, a panel of positive mesothelioma markers and positive carcinoma markers.
• The authors' conclusion: The author foresaw a time when claiming the need for tissue biopsy confirmation of a properly conducted cytological diagnosis of malignant mesothelioma would be a thing of the past, though the author was not certain when.
• Limitations the authors state:
  • The author stated that a comprehensive review of all attempted and emerging molecular technologies in pleuro-pulmonary cytopathology was beyond the scope of the editorial.
  • The author stated that the evolution of immunohistochemistry in cytology was not covered in this brief review.
  • The author noted that factors affecting false negative rates are seldom described in enough detail to allow meaningful comparison between published studies. These factors are case numbers, institutional expertise, team experience and specimen handling.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytopathology, Mesothelioma, Cytology, Lung Cancer.

Related studies

• Proceedings of the American Society of Cytopathology companion session at the 2019 United States and Canadian Academy of Pathology Annual meeting, part 2: effusion cytology with focus on theranostics and diagnosis of malignant mesothelioma — M.T. Siddiqui, F. Schmitt, et al. (2019)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary Statement from the International Mesothelioma Interest Group, Also Endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology — A. Hjerpe, V. Ascoli, et al. (2015)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology — A. Hjerpe, V. Ascoli, et al. (2015)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary statement from the international mesothelioma interest group, also endorsed by the international academy of cytology and the papanicolaou society of cytopathology. A proposal to be applauded and promoted but which requires updating — M. Sheaff (2020)
• Challenges and controversies in the diagnosis of mesothelioma: Part 1. Cytology-only diagnosis, biopsies, immunohistochemistry, discrimination between mesothelioma and reactive mesothelial hyperplasia, and biomarkers — D.W. Henderson, G. Reid, et al. (2013)
• Applying Probe Electrospray Ionization Mass Spectrometry to Cytological Diagnosis: A Preliminary Study by Using Cultured Lung Cancer Cells — Y. Morimoto, T. Oya, et al. (2021)

Browse more research in Diagnostic Cytopathology, or return to medical research.