Mesothelial proliferations: useful marker is not the same as a diagnostic one

Our plain-English summary of Mesothelial proliferations: useful marker is not the same as a diagnostic one, by A.N. Husain (American Journal of Clinical Pathology, 2014).

The study

• Author: A.N. Husain
• Journal: American Journal of Clinical Pathology
• Published: 2014;141(2):152-3
• Type of article: Editorial, Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial discussed the difficulty of distinguishing benign from malignant mesothelial proliferations, especially in small biopsy specimens without invasion of pre-existing tissue or obvious expansile growth, and in cytologic specimens. The author noted that expert panels in the United States, Canada and France had disagreed in 22% to 47% of circulated cases on whether a process was benign or malignant. The editorial commented on a study by Minato et al, published in the January 2014 issue of the journal. That study examined immunohistochemical staining for IMP3, GLUT1, EMA, CD146 and desmin in 34 malignant mesotheliomas and 40 reactive mesothelial cases. It reported 100% sensitivity and specificity using cutoffs of 40% for IMP3 and 0% for GLUT1. The author pointed out that these results came from a retrospective analysis of clear-cut, larger tissue samples. She also noted that the French MesoPath panel had concluded that desmin, EMA and p53 had no diagnostic usefulness in individual cases. The author discussed homozygous deletion of 9p21 (p16/CDKN2A). Almost all sarcomatoid mesotheliomas had this deletion, no reactive lesions tested so far had it, and only about 60% to 70% of pleural epithelioid mesotheliomas had it. The author concluded that larger studies were needed. The term "atypical mesothelial proliferation" was still recommended, to avoid giving unnecessary chemotherapy.

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 a two-page editorial by a pathologist at the University of Chicago, not an original study. It commented on a study by Minato and colleagues, published in the same journal, about using tissue stains to tell malignant mesothelioma apart from reactive (benign) mesothelial cells. The author noted that expert panels had disagreed in 22% to 47% of circulated cases on whether a process was benign or malignant. As the editorial described it, Minato and colleagues stained 34 malignant mesotheliomas and 40 reactive cases. They reported that sensitivity and specificity were both 100% using a 40% cutoff for the IMP3 stain and a 0% cutoff for the GLUT1 stain. The author pointed out that these results came from a retrospective analysis of clear-cut, larger tissue samples. The author also wrote that only about 60% to 70% of pleural epithelioid mesotheliomas carry a homozygous p16 deletion, so its absence does not rule out mesothelioma. The author concluded that larger studies are still needed. The editorial did not discuss asbestos.

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 published study (Minato et al) and the related literature; no original data
• Who was studied: No study population of its own. The editorial discusses Minato et al's study of 34 malignant mesotheliomas and 40 reactive mesothelial cases.
• Main results:
  • The author reported, citing another review, that US-Canadian and French expert panels disagreed in 22% to 47% of circulated cases on whether a mesothelial process was benign or malignant.
  • As described by the author, Minato et al found that with a 5% positive-cell cutoff, all their malignant mesothelioma cases were positive for at least two of the positive markers, except one relatively small biopsy specimen that was positive only for IMP3.
  • As described by the author, Minato et al found that with a cutoff of 40% for IMP3 and 0% for GLUT1, sensitivity and specificity for distinguishing malignant mesothelioma from reactive mesothelial cases were both 100%.
  • The author stated that only approximately 60% to 70% of pleural epithelioid mesotheliomas have the homozygous p16 deletion, so absence of the deletion does not rule out mesothelioma.
• The authors' conclusion: The author concluded that additional larger studies are needed before the diagnosis can be certain, and that the current recommendation is still to use the term 'atypical mesothelial proliferation' in such uncertain cases.
• Limitations the authors state:
  • The author noted that the Minato et al data, like most marker studies in the literature, came from a retrospective analysis of clear-cut larger tissue samples that were already histologically and clinically diagnostic.

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, Immunohistochemistry, GLUT1, Desmin, Malignant Mesothelioma, Homozygous Deletion, CDKN2A, Sarcomatoid.

Related studies

• Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations — K. Ikeda, G. Tate, et al. (2011)
• Comparative immunohistochemical analysis of IMP3, GLUT1, EMA, CD146, and desmin for distinguishing malignant mesothelioma from reactive mesothelial cells — H. Minato, N. Kurose, et al. (2014)
• IMP3 and GLUT-1 immunohistochemistry for distinguishing benign from malignant mesothelial proliferations — A.F. Lee, A.M. Gown, et al. (2013)
• Practical utility of insulin-like growth factor II mRNA-binding protein 3, glucose transporter 1, and epithelial membrane antigen for distinguishing malignant mesotheliomas from benign mesothelial proliferations — S. Chang, M.H. Oh, et al. (2014)
• Value of Glut-1 and Koc markers in the differential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and pulmonary adenocarcinoma — Ö. Üçer, A.F. Dağli, et al. (2013)
• Diagnostic value of BRCA1-associated protein-1, glucose transporter-1 and desmin expression in the discrimination between reactive mesothelial proliferation and malignant mesothelioma in tissues and effusions — S. Önder, E. Özogul, et al. (2019)

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