Current approaches, barriers, and future directions in pleural mesothelioma diagnostics: results from an Italian National Survey

Our plain-English summary of Current approaches, barriers, and future directions in pleural mesothelioma diagnostics: results from an Italian National Survey, by F. Pezzuto, G. Lopez, F. Barbisan, et al (Pathologica, 2025).

The study

• Authors: F. Pezzuto, G. Lopez, F. Barbisan, L. Rosso, G. Pelosi, M. Papotti, L. Righi, F. Calabrese
• Journal: Pathologica
• Published: 2025;117(4):366-373
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: This nationwide survey aimed to assess current diagnostic practices, adherence to international guidelines, and challenges encountered by Italian pathologists in the diagnosis of diffuse pleural mesothelioma (PM).

Methods: A structured questionnaire with 38 items was distributed electronically via Google Forms to Italian pathologists involved in mesothelioma diagnosis. Questions covered demographics, biopsy practices, pathology report, immunohistochemistry, molecular diagnostics, educational needs, and barriers to collaborative research.

Results: Participants represented diverse experience levels and institutional affiliations, primarily academic medical centers. Significant variability was found in tissue sampling and biobanking practices. Major diagnostic challenges included identifying sarcomatoid/desmoplastic patterns and inadequate adipose tissue in biopsies. Most pathologists managed inconclusive cases via multidisciplinary discussions and molecular analyses (BAP1, MTAP). Barriers identified included inadequate digital pathology infrastructure and limited standardized protocols for tissue collection. Participants strongly favored enhanced molecular resources, standardized histopathological protocols, and national collaborative initiatives.

Conclusions: Improved diagnostic accuracy requires targeted training, standardized protocols, enhanced molecular diagnostic capabilities, and structured national collaborations.

Copyright © 2025 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.

In plain English

This was a survey of Italian pathologists about how they diagnose diffuse pleural mesothelioma. It did not study patients or asbestos exposure. A 38-question online questionnaire went to 100 pathologists through the mailing list of an Italian pleural and lung pathology group (GIPP), and 55 responded. Most respondents (58.2%) worked at academic medical centers. The most often reported diagnostic difficulties were recognizing sarcomatoid or desmoplastic patterns (29.1%) and too little fatty (adipose) tissue in biopsies to judge invasion (25.5%). In addition, 14.5% cited limited clinical or exposure information. All respondents used the marker calretinin, and 90.9% routinely used BAP1 staining. MTAP staining was used by 30.9% of institutions, 54.5% used standardized reporting checklists, and 60% consistently reported tumor grade. Only 25.9% regularly collected extra material for research biobanks. Respondents pointed to wider molecular testing, standard protocols and national collaboration as opportunities for improvement. The authors concluded that the variability they found calls for collaboration, training and investment in digital and molecular pathology. The article contradicts itself on whether digital pathology infrastructure was a barrier.

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: Cross-sectional online questionnaire survey of pathologists (38 items), analyzed with descriptive statistics
• Who was studied: 55 Italian pathologists who responded, out of 100 pathologists specializing in or regularly involved in pleural mesothelioma diagnosis who were invited through the GIPP mailing list; participants had 7 weeks to respond; survey dates not stated
• Exposure: Not applicable: the survey studied diagnostic practices, not asbestos or other exposures
• Main results:
  • Of respondents, 36.4% had more than 20 years of pathology experience; 32 (58.2%) worked at academic medical centers
  • Annual pleural mesothelioma caseload among respondents: 45.5% saw 5-25 cases, 30.9% saw 25-50, 3.6% saw more than 50, and 20% saw fewer than 5
  • A minority of institutions (25.9%) regularly collected extra material such as pleural fluid or fresh tissue for biobanking; 74.1% did not
  • Difficulty identifying sarcomatoid/desmoplastic patterns was the most common diagnostic challenge: 16 respondents (29.1%)
  • Lack of adipose tissue complicating assessment of invasion was reported by 14 respondents (25.5%)
  • Limited availability of clinical/exposure data was a challenge for 8 respondents (14.5%)
  • All pathologists used calretinin (100%); other markers were WT1 (98.2%), D2-40 (72.7%) and CK5/6 (67.3%); mesothelin was used by 7.3%
  • BAP1 immunohistochemistry was routinely used by 90.9% of pathologists; BAP1 and MTAP results were routinely included in pathology reports by 78.2%
  • MTAP immunohistochemistry was used by 30.9% of institutions and p16 FISH by 23.6%
  • Standardized reporting checklists were used by 54.5%, and tumor grading was consistently reported by 60%
  • For inconclusive cases, multidisciplinary discussion and ancillary molecular analyses (mainly BAP1 and MTAP immunohistochemistry) were used by 78.6% of pathologists
  • 65.5% were very willing and 27.3% somewhat willing to share mesothelioma cases; paraffin-block transport was cited as a barrier by 1.8%; the Results section states no significant digital pathology barriers were noted
  • Opportunities for improvement included wider availability of molecular diagnostics such as next-generation sequencing, standardized grading and subclassification protocols, and national collaborations
• The authors' conclusion: The authors concluded that addressing the diagnostic variability and barriers found requires collaborative, resource-focused interventions, systematic training, and adoption of digital and molecular pathology, which they said could improve mesothelioma diagnosis

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: Pleural Mesothelioma, Mesothelioma, Biopsy, Pathology Report, Immunohistochemistry, Academic Medical Center, Sarcomatoid, Desmoplastic Mesothelioma.

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