The diagnosis of mesothelioma by panels

Our plain-English summary of The diagnosis of mesothelioma by panels, by W.T. McCaughey (American Journal of Industrial Medicine, 1991).

The study

• Author: W.T. McCaughey
• Journal: American Journal of Industrial Medicine
• Published: 1991;19(1):121-4
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003748).

Summary of the article

This historical article described how diffuse malignant mesothelioma (DMM) came to be diagnosed by panels of pathologists. The author explained that DMM is a rare, aggressive cancer of the linings of the body cavities, arising in the pleura in about 70% of cases. Accurate diagnosis matters because of its sentinel role for the cancer-causing effects of asbestos. Until the 1950s some doubted that DMM existed as a distinct tumor. Pathological studies between 1930 and 1960 established its features. After Wagner and colleagues reported in 1960 that many people with mesothelioma in South Africa had been exposed to asbestos, a 1964 recommendation led to national pathology reference panels in countries including Great Britain, the United States, Canada and the Netherlands. Panels graded tumors by diagnostic certainty, often on a 0-4 scale, and the majority opinion served as the working diagnosis. The author identified several weaknesses: the subjective nature of histological diagnosis, the varied microscopic appearance of DMM, and scanty material and clinical information. Other problems were cases seen by only a few panel members, diagnostic criteria that were not agreed, and panelists working in isolation. The author concluded that the panel system had almost certainly improved mesothelioma diagnosis. The eight to ten members of the United States-Canadian Mesothelioma Panel reached 75% or more agreement on 70% of referred material. Immunohistochemistry, electron microscopy and follow-up studies were said to further improve performance.

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 historical commentary, not a new study. The author, a member of the United States-Canadian Mesothelioma Panel, described how groups of pathologists ("panels") came to be used to diagnose diffuse malignant mesothelioma, a cancer of the lining of the body cavities that the author described as predominantly associated with asbestos. National panels were suggested in 1964 and became established in countries including Great Britain, the United States, Canada and the Netherlands. Panels graded tumors by how certain the diagnosis was, often on a 0 to 4 scale. The author wrote that complete agreement among panel pathologists was unusual. The author named several problems: scanty material and information sent to panels, diagnostic criteria often not agreed upon, and pathologists usually deciding alone. The author reported that in recent years the eight to ten members of the United States-Canadian panel reached 75% or more agreement on 70% of referred material, much of it difficult. The author concluded that the panel system had, despite its weaknesses, almost certainly improved mesothelioma diagnosis compared with individual experts.

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: historical perspective (narrative commentary), not original research
• Who was studied: No study population. The article discusses pathology reference panels for diagnosing diffuse malignant mesothelioma. These include the United States-Canadian Mesothelioma Panel, of which the author was a member, and panels in Great Britain, the United States, Canada and the Netherlands.
• Exposure: No exposure was studied. The article concerns diagnosis of diffuse malignant mesothelioma, which the author describes as predominantly associated with asbestos. No fiber types are discussed.
• Main results:
  • The author recounts that national pathology reference panels for mesothelioma diagnosis were suggested in 1964.
  • Panels graded tumors by degree of diagnostic certainty, often on a 0 to 4 numerical scale (0 meaning definitely not a mesothelioma, 4 meaning definite mesothelioma).
  • Complete agreement among a panel's pathologists was unusual, so the majority opinion was effectively the working diagnosis.
  • In the author's experience, the scarcity of material and information given to the panel pathologist was an obstacle to agreement.
  • The author states that diagnostic criteria were often not discussed in detail or agreed upon by panel members. The author also states that panelists usually made their diagnoses in isolation.
  • In recent years, the eight to ten members of the United States-Canadian Mesothelioma Panel reached 75% or more agreement on 70% of referred material, much of it difficult or controversial.
• The authors' conclusion: The author concluded that, despite its weaknesses, the panel system has almost certainly enhanced the overall quality of mesothelioma diagnosis compared with individual experts. The author added that immunohistochemistry and electron microscopy have improved objectivity, especially in telling diffuse malignant mesothelioma apart from metastatic adenocarcinoma.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Pleura, Pathology, Immunohistochemistry.

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• The search for the optimal immunohistochemical panel for the diagnosis of malignant mesothelioma — L.M. Weiss, H. Battifora (1993)

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