On the diagnosis of malignant pleural mesothelioma: A necropsy-based study of 171 cases (1997-2016)

Our plain-English summary of On the diagnosis of malignant pleural mesothelioma: A necropsy-based study of 171 cases (1997-2016), by E. Pira, P. Boffetta, C. Ciocan (Tumori, 2019).

The study

• Authors: E. Pira, P. Boffetta, C. Ciocan
• Journal: Tumori
• Published: 2019;105(4):359-360
• Type of article: Letter
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not an original study. Its authors commented on a same-titled study by Barbieri and colleagues that used necropsy (autopsy) findings to check diagnoses of malignant pleural mesothelioma. According to the letter, that study reported 119 cases with histologic confirmation. Of these, 89 were tested with immunohistochemistry (IHC) at the original diagnosis, and the results were consistent with mesothelioma in 83. The letter's authors said it was unclear how many of those 83 used currently recommended markers (two positive and two negative). They argued that proper validation needs blind assessment by independent readers. They questioned whether this was met, because it appeared that the same pathologists were involved in both the original diagnoses and the necropsies. One study author performed 62% of the necropsies. They also stated that Barbieri, the leading author, is expert witness for the plaintiff in current asbestos and mesothelioma litigation. They said this potential conflict was not mentioned in the appropriate section of the article. Two of the letter's authors declared acting as experts in asbestos and mesothelioma litigation, one of them for the defense.

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: Letter to the editor (commentary on another group's published study); no new data were collected
• Who was studied: The letter's authors studied no patients. They discussed the case series reported by Barbieri and colleagues, which included 119 cases with histologic confirmation, 89 of them tested with IHC at the original diagnosis.
• Main results:
  • The letter reported that, in Barbieri and colleagues' series, IHC at the original diagnosis was consistent with mesothelioma in 83 of 89 tested cases. The letter's authors said it was unclear how many of these 83 were based on currently recommended markers.
  • The letter's authors questioned whether the diagnoses were assessed blindly and independently. They gave as the reason that it appeared the same pathologists were involved in both the original diagnoses and the necropsies. One study author performed 62% of the necropsies.
  • Citing current guidance, the letter's authors stated that distinguishing mesothelioma from metastatic carcinoma should use a panel of at least 4 antibodies (2 in favor of mesothelioma, 2 against). They added that the diagnosis should never rest on a single IHC reaction.
  • Citing cytology guidelines, the letter's authors noted that some mesothelioma cases, including almost all sarcomatoid and desmoplastic types, cannot be diagnosed by cytology and need histologic material.
  • The letter's authors stated that Barbieri, the study's leading author, is an expert witness for the plaintiff in current litigation on asbestos and mesothelioma. In that same litigation, one of the letter's authors (E.P.) is expert witness for the defense. They stated that this potential conflict of interest was not mentioned in the appropriate section of the article.
• The authors' conclusion: The letter's authors argued that a proper validation of histology- or cytology-based mesothelioma diagnoses against necropsy should be based on blind assessment by independent, preferably multiple, readers. They also argued that diagnosis should rest on currently recommended IHC markers.

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: Pleural Mesothelioma, Autopsy.

Related studies

• On the diagnosis of malignant pleural mesothelioma: a necropsy-based study of 171 cases (1997-2016) — P.G. Barbieri (2019)
• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)
• Downregulated microRNAs in the differential diagnosis of malignant pleural mesothelioma — G.V. Gee, D.C. Koestler, et al. (2010)
• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• The histopathological diagnosis of malignant mesothelioma v. pulmonary adenocarcinoma: reproducibility of the histopathological diagnosis — B.G. Skov, A.F. Lauritzen, et al. (1994)

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