Changing clinical course of patients with malignant mesothelioma: implications for FNA cytology and utility of immunocytochemical staining

Our plain-English summary of Changing clinical course of patients with malignant mesothelioma: implications for FNA cytology and utility of immunocytochemical staining, by G.H. Yu, L. Soma, S. Hahn, et al (Diagnostic Cytopathology, 2001).

The study

• Authors: G.H. Yu, L. Soma, S. Hahn, J.S. Friedberg
• Journal: Diagnostic Cytopathology
• Published: 2001;24(5):322-7
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The diagnosis of both local recurrences and distant metastases of mesothelioma can be accomplished by fine-needle aspiration (FNA) biopsy. Although the previous history of mesothelioma provides strong support for recurrent/metastatic mesothelioma, other diagnostic possibilities (particularly adenocarcinoma) may require exclusion via special stains in some cases. In this study, we report on the morphologic findings in 13 cases of mesothelioma which underwent FNA (7 metastatic lesions, 6 local recurrences). In addition, immunohistochemical staining results for 7 cases with available material using antibodies directed against cytokeratin AE 1/3 and two antibodies reported to show consistently positive results in mesothelioma (calretinin and cytokeratin 5/6) are reported and compared to results seen for 10 cases of adenocarcinoma. All cases of mesothelioma and adenocarcinoma showed strong staining with cytokeratin AE 1/3. Three of 7 cases of mesothelioma showed strong staining with calretinin, while only focal staining was detected in 3 additional cases; only one case showed positive staining with cytokeratin 5/6. One of 10 cases of adenocarcinoma showed calretinin positivity; however, at least focal staining with cytokeratin 5/6 was seen in 4 cases. These results suggest that cytokeratin 5/6 is neither a sensitive nor specific stain for the diagnosis of mesothelioma in cytology material. Calretinin appears to be more specific for mesothelioma but showed disappointing sensitivity for this tumor, potentially limiting its diagnostic utility in FNA material.

Copyright 2001 Wiley-Liss, Inc.

In plain English

This was a review of pathology records at the Hospital of the University of Pennsylvania. It covered 13 fine-needle aspiration (FNA) biopsies from 12 patients, diagnosed as metastatic mesothelioma between 1995 and 1999. All patients had a history of pleural mesothelioma. Six biopsies were of presumed local recurrences and 7 were of distant metastases. In 7 cases with enough material, the authors tested three antibody stains and compared them with 10 cases of metastatic adenocarcinoma in body-fluid samples. All cases of both cancers stained strongly for cytokeratin AE 1/3. Calretinin stained 3 mesotheliomas strongly, 3 focally and 1 not at all, and was positive in 1 of the 10 adenocarcinomas. Cytokeratin 5/6 stained only 1 mesothelioma but at least focally stained 4 of the 10 adenocarcinomas. The authors concluded that cytokeratin 5/6 lacked both sensitivity and specificity, and that calretinin was more specific but had disappointing sensitivity in FNA material. They noted that the small amount of material may have affected the results. The article does not discuss asbestos exposure.

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: Retrospective case series from pathology files (fine-needle aspirates of recurrent or metastatic mesothelioma), with immunocytochemical staining compared against a group of metastatic adenocarcinoma cases
• Who was studied: 13 FNA cases from 12 patients (10 males, 2 females; mean age 62, range 49 to 77) with a history of pleural mesothelioma, Hospital of the University of Pennsylvania, Philadelphia, 1995 to 1999. The comparison group was 10 cases of metastatic adenocarcinoma in serous effusion specimens from 10 patients, retrieved from 1996 to 1997.
• Exposure: Asbestos exposure is not studied or reported. The study evaluated antibody stains (cytokeratin AE 1/3, calretinin, cytokeratin 5/6) for diagnosing metastatic mesothelioma.
• Main results:
  • Of the 13 mesothelioma FNA cases, 6 were presumed local recurrences and 7 were distant metastases.
  • Local recurrences developed 4 to 29 months after initial diagnosis. Distant metastases developed 4 months to 5 years after initial diagnosis.
  • In all 11 FNA cases with slides available for review, the cell appearance was compatible with mesothelioma.
  • All 7 stained mesothelioma cases showed strong, diffuse staining for cytokeratin AE 1/3.
  • In the 7 mesothelioma cases, calretinin was strongly positive in 3, focal in 3, and absent in 1.
  • Cytokeratin 5/6 stained only 1 of the 7 mesothelioma cases.
  • In the 10 adenocarcinoma cases, calretinin was positive in 1.
  • In the 10 adenocarcinoma cases, cytokeratin 5/6 stained tumor cells strongly in 1 and focally in 3.
  • The authors judged that cytokeratin 5/6 lacked both sensitivity and specificity in this study.
• The authors' conclusion: The authors concluded that cytokeratin 5/6 was neither sensitive nor specific for mesothelioma in cytology material. They found calretinin more specific but with disappointing sensitivity, potentially limiting its use in FNA material. In their view, the true utility of these 'positive' markers in this clinical scenario is thus far unproven.
• Limitations the authors state:
  • The limited amount of material available for staining may have contributed to the results.
  • Only metastatic lesions were studied, whereas most earlier calretinin studies used tissue from the primary tumor.
  • The authors stated that these issues need larger studies.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Cytology, Mesothelioma, Fine-Needle Aspiration, Biopsy, Adenocarcinoma, Immunohistochemistry, Calretinin.

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