Is Mesothelioma in China Rare or Misdiagnosed?

Our plain-English summary of Is Mesothelioma in China Rare or Misdiagnosed?, by T. John, P.A. Russell, B. Thapa (Journal of Thoracic Oncology, 2017).

The study

• Authors: T. John, P.A. Russell, B. Thapa
• Journal: Journal of Thoracic Oncology
• Published: 2017;12(4):607-609
• Type of article: Editorial, Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the authors commented on a study by Guo et al., published in the same issue, on the accuracy of mesothelioma diagnosis in China. In China, the reported incidence of malignant mesothelioma (MM) was lower than expected given cumulative and continued asbestos use. The authors suggested this might reflect reduced reporting or limited diagnostic accuracy. They linked accuracy to pathologist experience, access to adequate tissue, and use of an adequate panel of immunohistochemical (IHC) markers, which they summarized in a table. They stressed that biopsies including tissues outside the pleura were essential, because invasion outside the pleura is the most robust histologic indicator of malignancy. In their own retrospective review of pleural MM diagnosed between 1988 and 2014, using surgically obtained large biopsies, they were unable to establish the diagnosis in only five of 376 patients (1.5%). By contrast, Guo et al. confirmed MM in 52 of 92 cases (56%), including 12 of 34 pleural and 38 of 56 peritoneal tumors originally diagnosed as MM. The authors noted that these patients were young, predominantly female and had a limited history of asbestos exposure. They also discussed the limits of BAP1 and CAM5.2 as markers. They concluded that China's continued mining, use and export of chrysotile asbestos heightened the importance of accurate diagnosis and reporting of mesothelioma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was an editorial, not an original study. It commented on a study by Guo et al., in the same journal issue, about diagnosing malignant mesothelioma (MM) in China. The authors asked whether MM in China is rare or misdiagnosed. Guo et al. confirmed MM in 52 of 92 cases (56%) originally diagnosed as MM, including 12 of 34 pleural and 38 of 56 peritoneal tumors. Biopsy samples were inadequate to confirm the diagnosis in eight of 22 pleural (36%) and 10 of 18 peritoneal (55%) samples. The authors suggested the incorrect diagnoses were made mainly on how the tissue looked, using limited samples and no adequate panel of immunohistochemical markers. In the authors' own earlier review of pleural MM diagnosed between 1988 and 2014, which used large surgical biopsies, they could not confirm MM in five of 376 patients (1.5%). The authors concluded that biopsies need to be adequately sized, with attached tissue from outside the pleura, especially in centers with limited MM diagnostic experience. They added that China's continued use of chrysotile asbestos makes accurate diagnosis and reporting more important.

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 commenting on another study (Guo et al.) published in the same journal issue
• Who was studied: No new population was studied. The editorial discussed Guo et al.'s 92 cases in China originally diagnosed as MM, and the authors' own earlier retrospective review of 376 patients with pleural MM diagnosed between 1988 and 2014.
• Exposure: No exposure was studied directly. The editorial noted that Guo et al.'s patients had a limited history of asbestos exposure, and that chrysotile asbestos continues to be mined, used and exported in China.
• Main results:
  • In Guo et al.'s study, MM was confirmed in 52 of 92 cases (56%) originally diagnosed as MM, including 12 of 34 pleural and 38 of 56 peritoneal tumors.
  • In Guo et al.'s study, biopsy samples were inadequate for confirming the diagnosis in eight of 22 pleural (36%) and 10 of 18 peritoneal (55%) samples.
  • The authors described Guo et al.'s patients as young and predominantly female, with a limited history of asbestos exposure.
  • In the authors' own earlier review of pleural MM diagnosed between 1988 and 2014, the diagnosis could not be established in five of 376 patients (1.5%). All of their samples were surgically obtained large pleural biopsies.
  • The authors stated that loss or cytoplasmic localization of the marker BAP1 is seen in around 60% of MMs, which limits its sensitivity.
• The authors' conclusion: The authors concluded that biopsy samples need to be adequately sized, with attached tissue from outside the pleura, especially in centers with limited experience diagnosing MM. They also stated that China's continued mining, use and export of chrysotile asbestos heightens the importance of diagnostic accuracy and careful reporting.
• Limitations the authors state:
  • The authors noted that the false-negative rate in Guo et al.'s study was not known.

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: Mesothelioma, Malignant Mesothelioma, Pleura, Asbestos Exposure, BAP1, CAM5.2, Chrysotile.

Related studies

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• Diet and other risk factors for laryngeal cancer in Shanghai, China — W. Zheng, W.J. Blot, et al. (1992)
• Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data — S. Luo, X. Liu, et al. (2003)
• Burden of ovarian cancer in China from 1990 to 2030: A systematic analysis and comparison with the global level — Y. Wang, Z. Wang, et al. (2023)
• An updated review on asbestos and related diseases in China — M.N. Courtice, S. Lin, et al. (2012)
• Cancer risks among iron and steel workers in Anshan, China, Part I: Proportional mortality ratio analysis — Z. Xu, G.W. Pan, et al. (1996)

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