Is the cytodiagnosis of mesothelioma any easier these days?

Our plain-English summary of Is the cytodiagnosis of mesothelioma any easier these days?, by M. Nishino (Cancer Cytopathology, 2014).

The study

• Author: M. Nishino
• Journal: Cancer Cytopathology
• Published: 2014;122(12):857-8
• Type of article: Review
• Read it: PubMed · Publisher

In plain English

This article was a short expert opinion column (a 'Help Desk' piece) that reviewed published work. It did not report a new study. Drawing on earlier studies and a consensus report, the author described how pathologists can diagnose epithelioid mesothelioma from effusions, which are fluid samples collected from body cavities such as the space around the lungs. The author noted that such fluid samples cannot show invasive growth into tissue, a key sign used on tissue samples. The author also noted that cancer in these fluids is more often caused by spread of adenocarcinoma than by mesothelioma. The approach described had two steps. First, rule out spread of carcinoma and confirm the cells are mesothelial, using cell appearance and antibody stains. Second, confirm cancer using cell appearance plus a FISH test for loss of the 9p21 chromosome region. Reviewed studies reported this loss in 57%-92% of patients with mesothelioma effusions, with no false positives in benign cases reported to date. However, a negative result did not rule out mesothelioma. The author wrote that a history of asbestos exposure was neither sensitive nor specific for malignancy.

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: Expert opinion column reviewing published literature (not original research)
• Who was studied: No study population; the author summarized published studies of effusion cytology specimens comparing benign mesothelial cells with mesothelioma
• Exposure: Not an exposure study. Asbestos was mentioned only to say that a history of asbestos exposure is not a reliable guide to malignancy on cytology
• Main results:
  • Invasive growth into tissue, a key criterion on tissue samples, cannot be judged on cytology specimens
  • Malignant effusions are generally caused more often by metastatic adenocarcinoma than by mesothelioma
  • Several antibody markers studied for telling benign mesothelial cells from mesothelioma vary in performance between studies; their clinical value on effusion specimens was described as still evolving
  • In reviewed studies, deletion of the 9p21 locus was reported in 57%-92% of patients with effusions caused by mesothelioma
  • Across numerous reviewed studies, 9p21 deletions showed 100% specificity for malignancy, with no false-positive results in benign mesothelial proliferations reported to date
  • A negative 9p21 FISH result does not rule out mesothelioma
  • 9p21 deletion does not help distinguish mesothelioma from other malignancies
• The authors' conclusion: The author concluded that, with its caveats, 9p21 deletion appears to be a good rule-in test for malignancy in mesothelial proliferations. The practical approach the author recommended was to exclude metastatic carcinoma and confirm mesothelial differentiation, then confirm malignancy using cell appearance plus 9p21 FISH. The author added that tissue confirmation may still be pursued in cytologically positive cases.
• Limitations the authors state:
  • The cutoffs for calling a FISH test abnormal vary among the reviewed 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: Mesothelioma.

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• Talc deposition and effects after 20 days of repeated inhalation exposure of rats and mice to talc — J.A. Pickrell, M.B. Snipes, et al. (1989)

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