The cytology of malignant mesothelioma

Our plain-English summary of The cytology of malignant mesothelioma, by D. Whitaker (Cytopathology, 2000).

The study

• Author: D. Whitaker
• Journal: Cytopathology
• Published: 2000;11(3):139-51
• Type of article: Review
• Cited by: 99 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This invited review described the introduction, development and state of the art of cytopathology in diagnosing malignant mesothelioma. The author, from a cytology unit in Perth, Western Australia, noted that mesothelioma incidence had increased worldwide over 30 years, mainly in association with asbestos dust exposure. His institution saw a new case each week on average. Published sensitivities of effusion cytology ranged from 0 to 93%, with better results from laboratories with more experience. Other series reported 76% (51 cases) and 32% (29 cases), the latter attributed to sampling problems. The author reported a 100% predictive value for a positive diagnosis in serous effusions and a 73% sensitivity for fine needle aspiration. A history of asbestos exposure was described as helpful but not essential. The review covered key features of the cells and cell clusters, including collagen cores, and the use of special stains. In the author's experience, 98% of mesotheliomas showed strong EMA staining. In 16 adenocarcinomas and 26 mesotheliomas tested, all adenocarcinomas were negative and all mesotheliomas positive for calretinin and cytokeratin 5/6. The author recommended a five-antibody panel, electron microscopy in selected situations (including litigation), and a standard protocol. Problem areas included sparsely cellular fluids, often from sarcomatous mesotheliomas, and well-differentiated and desmoplastic tumours. The author concluded that the standardized approach gave a high degree of sensitivity and specificity.

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 invited review, by an author at the Western Australian Institute for Pathology and Medical Research in Perth, described how cytology (examining cells in fluid samples and needle aspirates) is used to diagnose malignant mesothelioma. It drew on published studies and on the author's own laboratory experience. It was not a study of asbestos exposure, although it noted that mesothelioma is mainly associated with prior exposure to asbestos dust. In an earlier review by the author's group, the sensitivity of cytological diagnosis across published series ranged from 0 to 93%. In the author's laboratory, a positive diagnosis in serous effusions had a predictive value of 100%, and 98% of mesotheliomas stained strongly with the marker EMA. In cell blocks, all 26 mesotheliomas stained positive for calretinin and cytokeratin 5/6, and all 16 metastatic adenocarcinomas stained negative. The author stated that a history of asbestos exposure is not essential for the diagnosis. The author recommended a routine panel of five markers: EMA, calretinin, cytokeratin 5/6 and two glandular markers.

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: invited narrative review of cytological diagnosis of malignant mesothelioma, including the author's institutional experience
• Who was studied: Published literature on mesothelioma cytology, plus cases seen at the author's institution in Perth, Western Australia (about one new mesothelioma case per week)
• Exposure: Not an exposure study; the article states that mesothelioma is mainly associated with prior exposure to asbestos dust, and no fiber types are named
• Main results:
  • In an earlier review by the author's group of publications over the previous 30 years, the sensitivity of cytological diagnosis of mesothelioma ranged from 0 to 93%, with better results from laboratories with a high local incidence of disease
  • In the author's laboratory, the predictive value of a positive diagnosis of malignant mesothelioma in serous effusions was 100%
  • In the author's laboratory, 98% of mesotheliomas gave a strong, often thick membrane reaction with EMA
  • Up to 14% of adenocarcinomas showed a similar thick membrane EMA pattern (author's unpublished results and those of King)
  • In serous effusion cell blocks tested by the author's group, all 16 metastatic adenocarcinomas stained negative for both cytokeratin 5/6 and calretinin, and all 26 mesotheliomas stained positive with both, with patchy staining in some cases
  • The author's group had earlier reported a sensitivity of 73% for fine needle aspiration (FNA) diagnosis
  • In the author's laboratory, the single cell presentation was seen in less than 10% of cases
  • In the author's laboratory, less than 15% of effusions were sparsely cellular, and these often proved to be from sarcomatous mesotheliomas
  • The author stated that a clinical history of asbestos exposure is not essential for a cytological diagnosis of mesothelioma
• The authors' conclusion: The author recommended a routine immunocytochemistry panel of five markers: EMA, calretinin, cytokeratin 5/6, and two glandular markers chosen from CEA, B72.3, LeuM1 and Ber-EP4

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, State-of-the-Art Defense, Cytopathology, Mesothelioma, Asbestos Exposure, Collagen, Adenocarcinoma.

Related studies

• Claudin-4 immunohistochemistry is highly effective in distinguishing adenocarcinoma from malignant mesothelioma in effusion cytology — V.Y. Jo, E.S. Cibas, et al. (2014)
• Small orangiophilic squamous-like cells: an underrecognized and useful morphological feature for the diagnosis of malignant mesothelioma in pleural effusion cytology — L. Chen, S.G. Caldero, et al. (2014)
• The diagnosis of malignant mesothelioma in effusion cytology: a reappraisal and results of a multi-institution survey — A. Paintal, K. Raparia, et al. (2013)
• A diagnosis of malignant pleural mesothelioma can be made by effusion cytology: results of a 20 year audit — A. Segal, G.F. Sterrett, et al. (2013)
• Use of cholesterol and soluble tumour markers CEA and syndecan-2 in pleural effusions in cases of inconclusive cytology — M. Gulyas, J. Fillinger, et al. (2019)
• Challenges and controversies in the diagnosis of mesothelioma: Part 1. Cytology-only diagnosis, biopsies, immunohistochemistry, discrimination between mesothelioma and reactive mesothelial hyperplasia, and biomarkers — D.W. Henderson, G. Reid, et al. (2013)

Browse more research in Cytopathology, or return to medical research.