Comments on the recently published "Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma"

Our plain-English summary of Comments on the recently published "Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma", by A. Hjerpe, K. Dobra (Cancer Cytopathology, 2015).

The study

• Authors: A. Hjerpe, K. Dobra
• Journal: Cancer Cytopathology
• Published: 2015;123(8):449-53
• Type of article: Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a commentary, not an original study. The authors described guidelines prepared by 17 cytopathologists from around the world for diagnosing epithelioid and mixed-type malignant mesothelioma from effusion fluid, a fluid collection that the authors said is often the first clinical sign of the disease and is withdrawn to relieve breathing. The International Mesothelioma Interest Group accepted these guidelines as a complement to earlier biopsy-based guidelines. The commentary summarized the guidelines' criteria. One step is establishing that cells are malignant. The other is establishing that they are mesothelial, using cell appearance plus additional tests. The guidelines call for at least 4 antibodies, 2 in favor of mesothelioma and 2 against it, because no single marker is fully specific. The authors stated that, depending on the tests available, a diagnosis could be made with 100% specificity and 60% to 75% sensitivity from the first effusion. They added that a negative finding does not exclude mesothelioma. They stated that cytology cannot diagnose sarcomatoid mesothelioma, and that biopsy is still indicated when cytology is inconclusive or when information on a possible sarcomatoid component is needed. The article did not address 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: Commentary on published diagnostic guidelines (no new patient data)
• Who was studied: No patients were studied. The article discussed guidelines written by 17 cytopathologists from around the world, accepted by the International Mesothelioma Interest Group and approved by the International Academy of Cytology and the Papanicolaou Society of Cytopathology.
• Exposure: No asbestos or other exposure was studied. The article concerns laboratory diagnosis of malignant mesothelioma from effusion cytology.
• Main results:
  • The authors stated that an effusion is often the first clinical sign of malignant mesothelioma and is withdrawn to relieve breathing.
  • The authors stated that, depending on the ancillary analyses available, a malignant mesothelioma diagnosis can be made from effusion cytology with 100% specificity and 60% to 75% sensitivity.
  • Because sensitivity is moderate, a negative cytology finding does not exclude mesothelioma.
  • The guidelines recommend at least 4 antibodies for immunocytochemistry: 2 in favor of mesothelioma and 2 against it.
  • A minimum antibody panel of EMA (membranous staining pattern), calretinin, CEA and Ber-EP4 was described.
  • Cytology cannot be used to diagnose sarcomatoid mesothelioma.
  • Biopsy remains indicated when cytology is inconclusive or when information on a possible sarcomatoid component is needed.
• The authors' conclusion: The authors concluded that the guidelines describe how a reliable cytologic diagnosis of malignant mesothelioma can be obtained, with a positive predictive value equal to that of histopathology, for clinical and medicolegal use.

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: Epithelioid, Malignant Mesothelioma.

Related studies

• 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)
• 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)
• Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: Ten Years of Clinical Experience in Relation to International Guidelines — A. Hjerpe, S. Abd-Own, et al. (2018)
• Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: a secondary publication — A. Hjerpe, V. Ascoli, et al. (2015)
• Metastatic proximal epithelioid sarcoma in pleural effusion: cytopathologic findings and differential diagnosis — H. Guan, F. Haque, et al. (2013)

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