Is there a need for expert opinion for biopsy diagnosis of difficult cases of malignant mesothelioma?

Our plain-English summary of Is there a need for expert opinion for biopsy diagnosis of difficult cases of malignant mesothelioma?, by S. Klebe, K.M. Griggs, M. Ely, et al (Pathology, 2012).

The study

• Authors: S. Klebe, K.M. Griggs, M. Ely, D.W. Henderson
• Journal: Pathology
• Published: 2012;44(6):562-3
• Type of article: Letter
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter reported a study of how often an 'expert' pathology opinion differed from the original biopsy diagnosis in difficult cases of possible malignant mesothelioma. The authors noted that this tumour is caused by inhalation of asbestos fibres and that the diagnosis often carries compensation implications. They retrieved 275 referral cases from the files of the Department of Anatomical Pathology at Flinders Medical Centre, Adelaide, for 2005–2010. The referring laboratories' original diagnosis was available for 262 of them. Of 136 cases referred as mesothelioma, the expert agreed in 117, gave a benign diagnosis in nine and diagnosed other tumours in two. Of 39 cases referred as benign mesothelial proliferation, 26 were confirmed and 11 (28%) were diagnosed as mesothelioma. Of 73 cases with no preferred diagnosis, 51 (70%) were reported as definite mesothelioma. Overall agreement was fair (kappa 0.3155), with 57% of cases in the same category. In 9.5% of cases there was a significant change, such as from benign to malignant or the reverse, or from another tumour type to mesothelioma. Agreement did not depend on the referring laboratory's state. Sarcomatoid mesothelioma was more problematic to diagnose than other subtypes (p = 0.016). The authors concluded that expert opinion can differ significantly from the referring diagnosis. Assuming the expert's opinion is more likely to be validated by follow-up, they concluded that the potential benefits of such a referral service justify its additional cost.

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

In this letter, the authors reviewed difficult biopsy cases sent for 'expert' opinion on malignant mesothelioma to Flinders Medical Centre, Adelaide, Australia, from 2005 to 2010. Of 275 cases retrieved, the referring laboratory's original diagnosis was available for 262. The referring pathologists called 136 cases malignant mesothelioma. The expert agreed in 117, gave a benign diagnosis in nine and diagnosed other tumours in two. Of 39 cases submitted as benign, 11 (28%) were diagnosed as mesothelioma by the expert. Of 73 cases with no preferred diagnosis, 51 (70%) were reported as definite mesothelioma. Overall, the original and expert diagnoses fell in the same category in 57% of cases, which the authors called only fair agreement. In 9.5% of cases the diagnosis changed significantly, for example from benign to malignant. Sarcomatoid mesothelioma was harder to diagnose than the other subtypes. The authors concluded that expert opinion can differ significantly from the original diagnosis. They said that, if the expert's opinion is more likely to be confirmed by follow-up, their findings support a need for such a service.

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: Retrospective review of referral (second-opinion) pathology cases, comparing the referring laboratory's diagnosis with the 'expert' diagnosis; published as a letter (correspondence)
• Who was studied: 275 referral cases from the files of the Department of Anatomical Pathology at Flinders Medical Centre, Australia, 2005–2010. The referring laboratory's original diagnosis was available for 262 of them. Referring laboratories were in New South Wales, Victoria and South Australia.
• Exposure: Not studied. This was a study of diagnostic agreement on biopsies; asbestos exposure was not assessed.
• Main results:
  • Of 136 samples the referring pathologists diagnosed as malignant mesothelioma (MM), the expert agreed in 117. In nine (7%) the expert gave a benign diagnosis, and in two the expert diagnosed other tumours (epithelioid haemangioendothelioma and synovial sarcoma).
  • Of 39 cases submitted as benign mesothelial proliferation, 26 were confirmed as benign. 11 (28%) were diagnosed as MM by the expert.
  • Of 73 cases with no preferred diagnosis (indeterminate benign/malignant) from the referring laboratory, 51 (70%) were reported as definite MM by the expert.
  • Overall agreement between original and expert diagnoses was only fair, with both diagnoses in the same category in 57% of the 262 cases.
  • In 9.5% of cases there was a significant change in diagnosis, which the authors said would significantly affect prognosis and compensation outcomes. The changes were benign to malignant or the reverse, or another tumour type to MM.
  • When diagnoses were split by certainty (probable or definite), agreement fell from fair to slight and was reached in only 31% of cases (data not shown).
  • The level of agreement did not depend on the state of the referring laboratory (New South Wales, Victoria, South Australia).
  • Sarcomatoid MM was more problematic to diagnose than the other MM subtypes (p 0.016). Desmoplastic sarcomatoid MM was no more difficult than the other sarcomatoid subtypes (p 0.353).
  • Overall concordance did not depend on how many immunohistochemical tests the referring laboratory performed (p 0.65). For sarcomatoid MM, however, significantly more tests had been done in discordant than in concordant cases (p 0.042).
• The authors' conclusion: The authors concluded that expert opinion can differ significantly from the referring laboratories' diagnosis. If the expert's opinion is more likely to be validated by follow-up, they said, their findings support a need for such a service, and the potential benefits appear to justify the cost.
• Limitations the authors state:
  • The authors' support for expert referral rested on the assumption that the expert's opinion is more likely to be validated by follow-up.
  • Follow-up information was limited, and provided for only about 80% of referral cases.

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: Biopsy, Malignant Mesothelioma, Pathology, Mesothelioma, Sarcomatoid.

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• Pleural biopsy in the diagnosis of malignant mesothelioma — A. Herbert, P.J. Gallagher (1982)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)

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