The evolving role of effusion cytology in the diagnosis of malignant mesothelioma

Our plain-English summary of The evolving role of effusion cytology in the diagnosis of malignant mesothelioma, by A. Paintal (Cytopathology, 2015).

The study

• Author: A. Paintal
• Journal: Cytopathology
• Published: 2015;26(3):137-8
• Type of article: Editorial, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a short editorial, not a research study. It reports no new data and does not discuss asbestos. The author commented on consensus guidelines by Hjerpe and colleagues, in the same issue, for diagnosing epithelioid and biphasic malignant mesothelioma from cells in fluid samples (effusion cytology). The author wrote that this practice is still not accepted in many quarters. The author argued that, in many cases, cell appearance, additional tests and clinical findings together can reliably allow a definitive diagnosis without biopsy. For effusions already shown to be mesothelial but only mildly atypical, the author noted that no immunohistochemical stain supporting malignancy has been reliably shown 100% specific, alone or combined. Citing earlier work, the author noted that homozygous deletion of p16, detected by FISH, was absolutely specific for malignancy in mesothelial proliferations. The author also wrote that cytology detects sarcomatoid mesothelioma much less well, and no criteria exist to reliably distinguish subtypes in these samples. This matters because sarcomatoid histology is a contraindication to surgery in most cases. The author called the guidelines a step forward, with room for refinement.

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 (commentary; no original data)
• Who was studied: No study population. The editorial comments on consensus guidelines by Hjerpe et al. published in the same issue of Cytopathology.
• Main results:
  • The author stated (as opinion, not a study finding) that diagnosing malignant mesothelioma from effusion cytology is still not accepted in many quarters.
  • The author argued that in many cases morphology, ancillary studies and clinical findings together can reliably allow a definitive diagnosis and make a tissue biopsy unnecessary.
  • For effusions that are morphologically mesothelial but show only mild atypia, the author stated that none of the immunohistochemical stains described as supporting malignancy in a demonstrably mesothelial effusion has been reliably shown to be 100% specific, alone or in combination.
  • Citing earlier work by others, the author noted that homozygous deletion of p16 (detected by FISH) has been found to be absolutely specific for malignancy in the context of a mesothelial proliferation.
  • The author wrote that studies have shown effusion cytology to be much less sensitive for sarcomatoid malignant mesothelioma than for epithelioid or biphasic types.
  • The author stated that criteria for reliably distinguishing epithelioid, sarcomatoid and biphasic malignant mesothelioma in cytological specimens currently do not exist.
  • The author noted that subtype matters because sarcomatoid histology is a contraindication to surgical intervention in most cases.
• The authors' conclusion: The author concluded that, although there is room for future refinement, the Hjerpe et al. consensus guidelines are a step forward in codifying the methods and role of cytological diagnosis of malignant mesothelioma in effusions.

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, Mesothelioma.

Related studies

• The diagnosis of malignant mesothelioma in effusion cytology: a reappraisal and results of a multi-institution survey — A. Paintal, K. Raparia, et al. (2013)
• Utility of BAP1 Immunohistochemistry and p16 (CDKN2A) FISH in the Diagnosis of Malignant Mesothelioma in Effusion Cytology Specimens — H.C. Hwang, B.S. Sheffield, et al. (2016)
• A combination of MTAP and BAP1 immunohistochemistry in pleural effusion cytology for the diagnosis of mesothelioma — Y. Kinoshita, T. Hida, et al. (2018)
• 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)
• Loss of expression of BAP1 is a useful adjunct, which strongly supports the diagnosis of mesothelioma in effusion cytology — J. Andrici, A. Sheen, et al. (2015)
• Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology — S. Savic, N. Franco, et al. (2010)

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