Stereological evaluation of malignant mesothelioma versus benign pleural hyperplasia

Our plain-English summary of Stereological evaluation of malignant mesothelioma versus benign pleural hyperplasia, by J. Bogers, W. Jacobs, K. Segers, et al (Pathology, Research and Practice, 1996).

The study

• Authors: J. Bogers, W. Jacobs, K. Segers, A. Van Daele, J. Weyler, E. Van Marck
• Journal: Pathology, Research and Practice
• Published: 1996;192(1):10-4
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The differential diagnosis between malignant mesothelioma and benign pleural hyperplasia constitutes a well-known problem. In the present study we examined unbiased stereological techniques to assess the mean nuclear volume (MNV) using the point-sampled intercepts (PSI) in 37 cases of malignant mesothelioma and in 28 cases of benign pleural hyperplasia. Neither the use of different fixatives nor the histological type of malignant mesothelioma produced any significant difference on the measured nuclear volume. The differences observed between the MNV data obtained from benign pleural hyperplasia and those from any of the three types of malignant mesothelioma were found to be highly significant. All lesions with an MNV larger than 250 microns3 were found in our study to correspond to the malignant mesothelioma type, while an MNV that was smaller than 200 microns3 could only be detected in benign specimens. These observations lead us to propose the MNV measurement using PSI as an additional tool to enhance the differential diagnosis of malignant mesothelioma versus benign pleural hyperplasia.

In plain English

This retrospective study from Belgium tested whether measuring the average volume of cell nuclei could help pathologists tell malignant mesothelioma apart from benign (non-cancerous) pleural hyperplasia. The authors examined stored samples from 37 malignant mesothelioma cases (29 epithelial, 4 mesenchymal, 4 mixed type), mostly biopsies, and 28 benign cases, mostly cell blocks from pleural fluid. They estimated mean nuclear volume with a computer-assisted technique called point-sampled intercepts. Nuclear volume was significantly larger in each of the three mesothelioma types than in the benign samples (p less than 0.001). Every sample above 250 cubic micrometres was mesothelioma, and values below 200 were seen only in benign samples. Between 200 and 250 the groups overlapped, so the measure could not help there. Fixative type, sample source and tumour type made no significant difference. Nuclear volume did not significantly predict survival. In 36 of 37 mesothelioma patients the disease was fatal, with a mean survival of 370 plus or minus 80 days. The authors concluded that the measurement could serve as an additional diagnostic tool. The study did not examine asbestos exposure.

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 study of archived pathology specimens, comparing a stereological measurement (volume-weighted mean nuclear volume, MNV, estimated by point-sampled intercepts) between malignant and benign pleural lesions, with survival analysis in the malignant cases
• Who was studied: Archived paraffin-embedded samples from 37 cases of malignant mesothelioma (29 epithelial, 4 mesenchymal, 4 mixed type) and 28 cases of benign pleural hyperplasia, examined at the Department of Pathology, University of Antwerp, Belgium. Malignant samples were 31 biopsies and 6 cell effusions; benign samples were 6 biopsies and 22 cell blocks. Cell suspensions were embedded in agar before fixation. Dates of the cases are not given.
• Exposure: Not studied. The article does not report asbestos or any other exposure; it measured nuclear size in tissue and cell samples.
• Main results:
  • Mean nuclear volume differed significantly between benign pleural hyperplasia and each of the three types of malignant mesothelioma (p less than 0.001), with smaller values in the benign lesions
  • When only AFA-fixed benign and AFA-fixed malignant cases were compared, to avoid bias from different fixatives, the difference was similarly significant (p less than 0.001)
  • All lesions with an MNV larger than 250 cubic micrometres were malignant mesothelioma; an MNV smaller than 200 cubic micrometres was found only in benign specimens
  • Because the two groups overlapped, the authors suggested using two threshold values; between 200 and 250 cubic micrometres the measurement could not aid the diagnosis
  • In malignant mesothelioma, the different fixatives produced no significant change in measured nuclear volume
  • Mean MNV (plus or minus standard error) in malignant mesothelioma by fixative: 340 plus or minus 30 cubic micrometres for B5, 330 plus or minus 20 for AFA and 290 plus or minus 10 for FNB; the authors reported this difference as not statistically significant
  • Neither sample type (cell blocks from pleural effusions versus biopsies) nor histological type of mesothelioma significantly affected MNV
  • In the malignant mesothelioma cases, a Kaplan-Meier analysis dividing cases into three MNV groups (under 250, 250 to 350, and over 350 cubic micrometres) showed no prognostic significance
  • A Cox model comparing cases with MNV less than 200 cubic micrometres against cases with MNV more than 200 gave a hazard ratio of 2.10 (95% confidence interval 0.22 to 20.2); a log-rank test with a 200 cut-off showed no significance
  • Follow-up of the malignant group: in 36 of 37 patients the disease was fatal, with a mean survival of 370 plus or minus 80 days
• The authors' conclusion: The authors concluded that measuring MNV with point-sampled intercepts could serve as an additional tool in distinguishing malignant mesothelioma from benign pleural hyperplasia
• Limitations the authors state:
  • Benign and malignant values overlapped, so between 200 and 250 cubic micrometres the measurement could not help the diagnosis
  • Small numbers of cases in the B5 and FNB fixative groups may explain why no fixative effect was found
  • MNV in some cases changed considerably between different regions of the same tumour

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, Differential Diagnosis.

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