Diagnosis of pleural malignant mesothelioma in life--a practical approach

Our plain-English summary of Diagnosis of pleural malignant mesothelioma in life--a practical approach, by D. Whitaker, K.B. Shilkin (The Journal of Pathology, 1984).

The study

• Authors: D. Whitaker, K.B. Shilkin
• Journal: The Journal of Pathology
• Published: 1984;143(3):147-75
• Type of article: Review
• Cited by: 119 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001680).

Abstract

This review documents a practical approach to the pathological diagnosis of pleural malignant mesothelioma based on the closed needle biopsy and effusion cytology, thus avoiding the need to resort to open surgery. Tissue diagnosis is often difficult, and the pathologist's opinion may be influenced by a consideration of three factors: the clinical setting; the adequacy and availability of specimens; and the criteria for assessment and interpretation of these. The level of confidence with which a tissue diagnosis of mesothelioma can be established using limited material depends on there being an appropriate clinical background including a history of asbestos exposure. Without this, the diagnosis should be a qualified or tentative one. For an adequate tissue sample to be obtained, the closed needle biopsy procedure is best performed by an experienced operator. All aspirated pleural effusions should be forwarded for cytological evaluation. In addition to conventional morphological studies, adequate samples permit ancillary tests to be carried out. A combined interpretive approach utilizing both histopathology and cytology is recommended in order to increase the accuracy of the diagnosis.

In plain English

This review described a practical approach to diagnosing pleural malignant mesothelioma during life, without open chest surgery, using closed needle biopsy of the pleura and cytology of pleural fluid. It drew on published work and the authors' own 10 years of experience; they worked at Sir Charles Gairdner Hospital, Western Australia. In a series of 70 confirmed mesothelioma cases the authors analysed, 39 per cent were correctly diagnosed by the first needle biopsy and 50 per cent on cytological morphology alone, rising to 80 per cent with both combined. Their department's cytology sensitivity rose from 25 per cent before 1975 to 62 per cent. The authors said this may partly reflect asbestos exposure information on request forms and their special interest. Six of ten mesothelioma effusions they tested had hyaluronic acid above 200 mg per litre. None of six benign or five metastatic malignant effusions exceeded 90 mg per litre. The authors stressed that no absolute criteria exist for diagnosis on small biopsies alone, and that confidence depends on a suitable clinical background including asbestos exposure. They recommended combining histopathology and cytology.

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: Narrative review of diagnostic methods, drawing on published studies and the authors' own laboratory experience
• Who was studied: The authors' own mesothelioma cases and specimens (closed needle pleural biopsies and pleural effusions) from their experience over the past 10 years, including a series of 70 confirmed mesothelioma cases. The authors were affiliated with Sir Charles Gairdner Hospital, Western Australia; the article does not say where all of this experience was gained.
• Exposure: No specific fiber type or dose was studied. A history of asbestos exposure was treated as part of the clinical background that affects how confidently mesothelioma can be diagnosed from limited material.
• Main results:
  • In the authors' series of 70 confirmed mesothelioma cases, 39 per cent were correctly diagnosed by the initial needle biopsy and 50 per cent on cytological morphology alone
  • In the same series of 70 cases, combining biopsy and cytology raised the proportion diagnosed to 80 per cent
  • In the authors' material, 15 per cent of mesothelioma cases had no recognizable mesothelial cells on the initial needle biopsy
  • In the authors' department, effusion cytology correctly diagnosed mesothelioma on 25 per cent of occasions before 1975. At the time of writing its sensitivity was 62 per cent.
  • The share of mesothelioma pleural effusions sent to the authors' laboratory rose from 72 per cent before 1975 to 92 per cent at the time of writing
  • About 75 per cent of the authors' mesothelioma cases had an effusion
  • The authors measured hyaluronic acid in effusions from ten cases of mesothelioma, six benign effusions and five metastatic malignant effusions
  • Six of the ten mesothelioma effusions contained more than 200 mg of hyaluronic acid per litre, the highest being 3130 mg per litre. None of the benign or metastatic effusions contained more than 90 mg per litre.
  • The authors identified four cases of metastatic mesothelioma in sputum samples
  • In one case, a 29-year-old female whose fluid was repeatedly sent for cytology, mesothelioma was raised only on the third sample and later proven. She had spent her childhood in an asbestos mining town with frequent asbestos contact.
  • With the EMA antigen test, all adenocarcinoma and mesothelioma cases the authors studied stained strongly positive (number of cases not given)
• The authors' conclusion: The authors recommended a combined interpretive approach using both histopathology (needle biopsy) and cytology (pleural fluid) to increase diagnostic accuracy
• Limitations the authors state:
  • The authors said their cytology success rate may be partly explained by asbestos exposure information on request forms and by their special interest in mesothelioma cytology
  • The authors stated that no absolute criteria exist for a definitive diagnosis of mesothelioma on small needle biopsies alone
  • The authors had no personal experience with cytogenetics or morphometry as ancillary tests

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, Needle Biopsy, Cytology, Mesothelioma, Asbestos Exposure, Pleural Effusion, Histopathology.

Related studies

• Pleural fluid CEA levels in the diagnosis of malignant mesothelioma — D. Whitaker, K.B. Shilkin, et al. (1986)
• Asbestos dust concentrations in ship repairing: a practical approach to improving asbestos hygiene in naval dockyards — P.G. Harries (1971)
• Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach — D. Nowak, B. Schmalfeldt, et al. (2021)
• Recent Advances in the Diagnosis of Malignant Mesothelioma: Focus on Approach in Challenging Cases and in Limited Tissue and Cytologic Samples — S. Monaco, M. Mehrad, et al. (2018)
• Pathology reporting of malignant pleural mesothelioma first diagnosis: A population-based approach — V. Ascoli, G. Minelli, et al. (2016)
• Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens — E.J. Wills, S. Carr, et al. (1987)

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