The usefulness of expert opinion in medicolegal referrals of malignant mesothelioma

Our plain-English summary of The usefulness of expert opinion in medicolegal referrals of malignant mesothelioma, by D.L. Dixon, K.M. Griggs, M. Ely, et al (Pathology, 2013).

The study

• Authors: D.L. Dixon, K.M. Griggs, M. Ely, D.W. Henderson, S. Klebe
• Journal: Pathology
• Published: 2013;45(5):523-5
• Type of article: Letter
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This published letter reviewed 524 suspected malignant mesothelioma cases from one author's medicolegal files for 2005 to 2010. The authors compared each original laboratory diagnosis with the later 'expert' opinion. Of 330 cases first diagnosed as mesothelioma, the expert agreed in 316, gave another cancer diagnosis in three (1%) and reached no definite diagnosis in 11 (3%). Of 47 cases first called benign, three (6%) were diagnosed as definite mesothelioma, all desmoplastic. Of 110 with another diagnosis, eight became mesothelioma, all sarcomatoid. Of 37 with no definite diagnosis, 30 (81%) were diagnosed as mesothelioma. Overall agreement was substantial (kappa 0.747), and 2% of cases changed between benign and malignant or from another diagnosis to mesothelioma. Agreement fell to moderate (kappa 0.554, 70% of cases) when probable and definite diagnoses were separated. Subtype agreement was lowest for biphasic mesothelioma. The number of immunohistochemical tests did not affect overall concordance. The authors concluded their findings supported an expert opinion service, since a definite mesothelioma diagnosis was reached for an additional 41 patients (8%).

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 review comparing original pathology diagnoses with later 'expert' opinions in medicolegal referrals, published as a letter (correspondence)
• Who was studied: 524 cases retrieved from the medicolegal files of one author (DWH) for 2005 to 2010; 86% of patients were male
• Exposure: Not studied: the article examined pathology diagnoses of suspected mesothelioma, not asbestos exposure
• Main results:
  • Of 330 cases the referring pathologists diagnosed as mesothelioma, the expert agreed in 316. In three (1%) the expert gave a malignant diagnosis other than mesothelioma: adenocarcinoma in two and low grade sarcoma in one. In 11 (3%) the expert reached no definite diagnosis.
  • Of 47 cases submitted as benign mesothelial proliferation, 38 (81%) were confirmed as benign and three (6%) were diagnosed as definite mesothelioma, all of desmoplastic type
  • Of 110 cases submitted with a diagnosis other than a mesothelial lesion, 98 (89%) were confirmed and eight were diagnosed as definite mesothelioma, all of sarcomatoid subtype
  • Of 37 cases submitted with no definite diagnosis, the expert diagnosed definite mesothelioma in 30 (81%) and benign disease in three
  • Overall agreement between original and expert diagnosis was substantial (kappa 0.747). The diagnosis changed from benign to malignant, or from another diagnosis to mesothelioma, in 2% of cases.
  • When diagnoses were split by level of certainty (probable or definite), agreement fell to moderate (kappa 0.554), with agreement in 70% of cases
  • By histological subtype, concordance was lowest for biphasic mesothelioma
  • The number of immunohistochemical studies done by the primary laboratory did not affect concordance for mesothelioma overall (n = 339, p = 0.83)
  • Primary laboratories used calretinin in 364 cases (70%) and BG8 in 11 cases (2%), out of 521 cases with immunohistochemistry details
  • Cases left undiagnosed by the primary pathologist had more immunohistochemical tests (median 8, range 0 to 24) than cases that were diagnosed (median 6, range 0 to 13)
• The authors' conclusion: The authors concluded that their findings support the need for an expert opinion service: an additional 41 patients (8%) received a definite mesothelioma diagnosis, and three (1%) diagnosed with mesothelioma received another diagnosis. They wrote that the potential benefits may justify the cost to the legal system.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Is there a need for expert opinion for biopsy diagnosis of difficult cases of malignant mesothelioma? — S. Klebe, K.M. Griggs, et al. (2012)
• Guideline for referral of patients with suspected lung cancer by family physicians and other primary care providers — M.E. Del Giudice, S.M. Young, et al. (2014)
• Expert witness testimony: A trial judge's perspective — J.B. Weinstein (1999)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)
• Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma — C. Pinto, A. Ardizzoni, et al. (2011)

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