Methods to improve the diagnostic accuracy of malignant mesothelioma

Our plain-English summary of Methods to improve the diagnostic accuracy of malignant mesothelioma, by A. Dejmek (Respiratory Medicine, 1996).

The study

• Author: A. Dejmek
• Journal: Respiratory Medicine
• Published: 1996;90(4):191-9
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This topical review from Malmö University Hospital, Sweden, described methods intended to improve the diagnosis of diffuse malignant mesothelioma, a tumour for which asbestos was named as the most significant cause. The author noted that early diagnosis mattered for medical and medicolegal reasons. Distinguishing mesothelioma from adenocarcinoma and from benign mesothelial hyperplasia was described as difficult. Reported accuracy was close to 100% for thoracoscopy, up to 60% for closed needle biopsy, and varied widely for effusion cytology, from 4% to a sensitivity of 62%. The review then covered ancillary techniques. These were electron microscopy (for example, long, slender microvilli), histochemical stains (Alcian blue with hyaluronidase, PAS after diastase, and mucicarmine), and immunocytochemistry with markers including CEA, intermediate filaments, EMA, Leu M1, B72.3, BerEp, extracellular matrix proteins and others. Because no single antibody separated mesothelioma from adenocarcinoma, antibody panels were recommended. One panel of anti-CEA, anti-EMA and B72.3 resolved over 95% of cases. In the author's own study of 103 mesotheliomas and 43 adenocarcinomas, logistic regression selected five parameters. The review also described measuring hyaluronan in effusions. With an HPLC method, a value of 75 mg/l was reported as 100% specific for mesothelioma. The author concluded that a multimodal approach using ancillary techniques could give a correct diagnosis from small tissue samples in a considerable number of cases.

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 article was a topical review by a single author from a hospital pathology department in Sweden. It described methods for improving the accuracy of diagnosing diffuse malignant mesothelioma, a tumour of the body's serous cavities that most often arises in the pleura. It reported no new patient data. The review noted that asbestos is the most significant cause, and that the main diagnostic difficulty is telling mesothelioma apart from adenocarcinoma and from benign mesothelial hyperplasia. It summarized published work on electron microscopy, histochemical stains, antibody staining (CEA, EMA, Leu M1, B72.3, BerEp and others) and measurement of hyaluronan in effusion fluid. In one cited study, cell testing of effusion fluid had a sensitivity of 62%. In another, a hyaluronan level of 75 mg per litre, measured by HPLC, was 100% specific for mesothelioma. The review stated that no single antibody separates the two tumours, so panels of antibodies are recommended. The author concluded that combining several methods, including these ancillary techniques, can give a correct diagnosis from a small amount of tissue in a considerable number of cases.

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: Topical (narrative) review of published literature, including the author's own earlier studies
• Who was studied: No study population. The review covered published studies on diagnosing diffuse malignant mesothelioma. Methods for selecting the studies are not stated.
• Exposure: Not studied. Asbestos is named in the introduction as the most significant cause of mesothelioma. No fiber types are discussed.
• Main results:
  • The review reported that the diagnostic accuracy of smears from effusions varies widely between studies. Whitaker and Shilkin reported a sensitivity of 62%, and a 1970s study reported an accuracy rate of 4%.
  • For thoracoscopy, the review cited reported accuracy rates close to 100%. For closed needle biopsy, Edge and Choudhury claimed a 60% success rate, and lower figures are usually reported.
  • In the author's earlier comparison of five commercially available monoclonal CEA antibodies, only the Dakopatts preparation was sufficiently specific.
  • The review stated that no single antibody differentiates adenocarcinoma from mesothelioma, so batteries (panels) of antibodies are usually recommended. Frisman et al. found that a panel of anti-CEA, anti-EMA and B72.3 resolved over 95% of cases.
  • In the author's own earlier study of 103 mesotheliomas and 43 adenocarcinomas, stepwise logistic regression selected five staining parameters of major importance.
  • For hyaluronan in effusions, one cited study using the HPLC method found a value of 75 mg per litre to be 100% specific for mesothelioma. With a radioassay method, a considerable number of effusions from non-malignant diseases also showed elevated levels.
• The authors' conclusion: The author concluded that a multimodal approach, including ancillary techniques, makes it possible to reach a correct morphological diagnosis from a small amount of tissue in a considerable number of cases.
• Limitations the authors state:
  • The author noted that for many of the antibodies tested, the number of cases has usually been small and few authors have investigated them.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Adenocarcinoma, Reactive Mesothelial Hyperplasia, Thoracoscopy, Needle Biopsy, Cytology, B72.3 (TAG-72).

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