Should cytology be an acceptable means of diagnosing malignant mesothelioma?

Our plain-English summary of Should cytology be an acceptable means of diagnosing malignant mesothelioma?, by M. Sheaff (Cytopathology, 2011).

The study

• Author: M. Sheaff
• Journal: Cytopathology
• Published: 2011;22(1):3-4
• Type of article: Comment, Editorial
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial accompanied a review article by Davidson in the same issue and discussed whether cytology should be an acceptable means of diagnosing malignant mesothelioma. The author noted that reactive mesothelial cell proliferations and other cancers can closely resemble mesothelioma in cytological preparations, so the definitive diagnosis is usually based on histology, which can also confirm tissue invasion. He stated that most agree the diagnosis can at least be suspected from a fluid sample. This matters for treatment, and because cytology may be the only pathological material available for people with mesothelioma from occupational asbestos exposure who are seeking compensation. British, European, international and American guidelines were described as acknowledging a role for cytology while favouring tissue diagnosis for final confirmation. The author identified the lack of a marker specific for mesothelioma as a central problem, particularly for separating reactive from malignant mesothelium and for distinguishing peritoneal mesothelioma from serous adenocarcinoma in women. He described a female patient whose pleural serous adenocarcinoma was later traced to an endometrial primary. He used this case to stress close clinical and radiological correlation and to note that serous carcinomas are not usually considered asbestos-related. He concluded that immunocytochemistry on cell blocks is widely available and that molecular research might one day identify a unique marker supporting a dependable cytological diagnosis.

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 an editorial, not a research study. It commented on a review by Davidson published in the same issue of the journal and gave the author's views on whether cytology (examining cells in fluid samples) can be used to diagnose malignant mesothelioma. The author wrote that guidelines from several bodies acknowledged a role for cytology but tended to favour a tissue diagnosis. The author also wrote that no single marker was entirely specific for malignant mesothelioma. In women, primary serous adenocarcinoma was described as a troublesome mimic of peritoneal mesothelioma. The author noted that cytology may be the only diagnostic material available for people who develop mesothelioma from occupational asbestos exposure and are seeking compensation. The author described one woman with a pleural effusion whose cancer, nearly two years later, was considered to have come from the endometrium. The editorial stated that cell blocks made from cytological samples give results equivalent to biopsy material, while molecular techniques were largely limited to specialist units. The author hoped a unique marker might one day be found.

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 a review article by Davidson in the same journal issue; no original study data
• Exposure: No exposure was studied. The editorial noted that cytology may be the only pathological material available for people who develop mesothelioma from occupational asbestos exposure and are pursuing compensation. It also stated that serous carcinomas are not usually considered related to asbestos exposure, whereas most mesotheliomas are.
• Main results:
  • The author stated that the British Thoracic Society, European Respiratory Society and European Society of Thoracic Surgeons, International Mesothelioma Interest Group and American Thoracic Society all acknowledge a role for cytology but tend to favour a tissue diagnosis for final confirmation.
  • The author stated that no single marker is entirely specific for malignant mesothelioma or its mimics.
  • In women, primary serous adenocarcinoma was described as a particularly troublesome mimic of peritoneal malignant mesothelioma.
  • The author described one female patient with a malignant pleural effusion found to be an adenocarcinoma with a serous carcinoma immunophenotype. She re-presented nearly 2 years later with a high-grade serous adenocarcinoma of the endometrium, which in retrospect was considered the source of the pleural metastases.
  • The author stated that cell blocks made from cytological samples allow results equivalent to biopsy material (some say superior).
  • The author stated that molecular techniques were largely restricted to specialist units at the time.
• The authors' conclusion: The author concluded that, with refinement of techniques and molecular adjuncts, a unique marker for malignant mesothelioma might one day be found, which should allay some of the prejudices of those who do not believe in a dependable cytological diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytology, Malignant Mesothelioma, Mesothelial Cells, Mesothelioma, Histology, Asbestos Exposure, Mesothelium, Peritoneal Mesothelioma.

Related studies

• Proceedings of the American Society of Cytopathology companion session at the 2019 United States and Canadian Academy of Pathology Annual meeting, part 2: effusion cytology with focus on theranostics and diagnosis of malignant mesothelioma — M.T. Siddiqui, F. Schmitt, et al. (2019)
• The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience — E.D. Rossi, T. Bizzarro, et al. (2015)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary Statement from the International Mesothelioma Interest Group, Also Endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology — A. Hjerpe, V. Ascoli, et al. (2015)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary statement from the international mesothelioma interest group, also endorsed by the international academy of cytology and the papanicolaou society of cytopathology. A proposal to be applauded and promoted but which requires updating — M. Sheaff (2020)
• Investigating unilateral pleural effusions: the role of cytology — D.T. Arnold, D. De Fonseka, et al. (2018)
• Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology — A. Hjerpe, V. Ascoli, et al. (2015)

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