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

Our plain-English summary of 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, by M. Sheaff (Diagnostic Cytopathology, 2020).

The study

• Author: M. Sheaff
• Journal: Diagnostic Cytopathology
• Published: 2020;48(10):877-879
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma produced by the International Mesothelioma Interest Group and which are endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology are reviewed and discussed. This (predominantly) evidence-based document provides a robust and useful framework for diagnosticians and guideline producers to emphasise and promote the value, power and role of cytology in mesothelioma diagnosis and management with comments and suggestions about how the guidelines can be updated and improved in the future.

© 2019 Wiley Periodicals, Inc.

In plain English

This article was a commentary, labelled a review article, in which the author appraised published guidelines from the International Mesothelioma Interest Group (IMIG) on using cytology to diagnose epithelioid and mixed-type malignant mesothelioma. Cytology means examining cells, for example from fluid that collects around the lung. The article reported no new patient data. The author wrote that the guidelines made a good case that a tissue biopsy need not be compulsory for these forms of the disease. The author noted that this seemed to contradict a British Thoracic Society statement. The author criticised the guidelines' scant discussion of histology and surgical biopsy, an unreferenced statement about the markers calretinin and BerEP4, and the limited availability of electron microscopy. The author argued that an update should add newer antibodies such as GLUT1, IMP3, BAP1 and possibly MTAP, along with newer molecular methods. The author also wanted a fuller discussion of how cytology-only diagnosis affects medicolegal cases. The author concluded that, in suitable cases, a cytology sample can be diagnostic of malignant mesothelioma, and that the guidelines require updating.

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 (labelled a review article) appraising a published diagnostic guideline; no new data
• Who was studied: The IMIG guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma (Hjerpe et al., Diagnostic Cytopathology 2015)
• Main results:
  • The author wrote that the guidelines argue tissue diagnosis is unnecessary as a compulsory step in epithelioid and mixed forms of mesothelioma.
  • The author noted that this position seemed to contradict the most recent British Thoracic Society statement on mesothelioma.
  • The author criticised the guidelines for scant reference to histology, only fleeting reference to core biopsy, and no discussion of video assisted thoracic surgery (VATS).
  • The author pointed out an unreferenced statement in the guidelines that calretinin positivity overrides BerEP4 in troublesome cases.
  • The author noted that electron microscopy facilities are not widely available in many places.
  • The author stated that newer antibodies (GLUT1, IMP3, BAP1, and possibly MTAP) need to be included in any update.
  • The author stated that the only well-founded, currently routinely available molecular technique for mesothelioma diagnosis is FISH for p16 deletion.
  • The author wanted a fuller discussion of how cytology-only diagnosis affects medicolegal cases.
• The authors' conclusion: The author concluded that, in suitable cases with appropriate clinical and radiological features and clear cytological findings, a cytology sample can be diagnostic of malignant mesothelioma, and that the guidelines require some updating.

Topics

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

Medical terms in this study, explained in our Lexicon: Epithelioid, Malignant Mesothelioma, Mesothelioma, Cytology, Cytopathology.

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. Hjerpe, V. Ascoli, et al. (2015)
• Comments on the recently published "Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma" — A. Hjerpe, K. Dobra (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)
• 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: a secondary publication — A. Hjerpe, V. Ascoli, et al. (2015)

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