Mesothelioma - Update on Diagnostic Strategies

Our plain-English summary of Mesothelioma - Update on Diagnostic Strategies, by C.M. Rosario, X. Lin, D.W. Kamp (Clinical Pulmonary Medicine, 2012).

The study

• Authors: C.M. Rosario, X. Lin, D.W. Kamp
• Journal: Clinical Pulmonary Medicine
• Published: 2012;19(6):282-288
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) can be a challenging diagnosis for clinicians to make as it is often difficult to distinguish from benign asbestos pleural effusions and metastatic carcinomas. In this review, we present a case of MPM and discuss clinical manifestations, traditional diagnostic techniques, and the role of cytopathologic immunostains and serum biomarkers in the diagnosis of MPM.

In plain English

This article was a review by three Northwestern University authors on diagnosing malignant pleural mesothelioma. It opened with one case report: a 77-year-old man who had worked as a pipefitter for over 50 years with known asbestos exposure. Tests on fluid from his chest and a later thoracoscopic biopsy confirmed epithelioid malignant mesothelioma. The authors then summarized other researchers' studies. They reported that fluid cytology and needle biopsy often miss the disease, and that European guidelines recommend at least four tissue stains. For the blood marker SMRP, they cited a meta-analysis of 11 studies with pooled sensitivity of 64% (95% confidence interval 61% to 68%) and specificity of 89% (88% to 90%). They also cited a study of 538 asbestos-exposed patients, including people with benign asbestos-related disease, in which none of the 15 with high SMRP had mesothelioma. The authors concluded that diagnosis still requires examining tissue, usually from a thoracoscopic biopsy, together with a stain panel. They said blood markers should not be used alone to diagnose the disease, though SMRP may help in judging prognosis.

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: Narrative review of diagnostic methods for malignant pleural mesothelioma, opening with a single case report
• Who was studied: Case report of one patient: a 77-year-old white man with a 20 pack-year smoking history. The review section summarized published studies of patients with mesothelioma and comparison groups.
• Exposure: For the case patient: occupational asbestos exposure over a 50-year period as a pipefitter, with limited use of protective devices such as a respiratory mask. No fiber type was named.
• Main results:
  • Case patient: the abnormal cells in his pleural fluid stained positive for calretinin, cytokeratin 5/6 and Wilms tumor-1 (WT-1). They were negative for polyclonal carcinoembryonic antigen (pCEA) and CD15.
  • Case patient: a video-assisted thoracoscopic pleural biopsy confirmed malignant mesothelioma, epithelioid subtype.
  • From cited studies: sensitivity was 25% to 33% for pleural fluid cytology and 21% to 77% for closed-needle pleural biopsy.
  • European Respiratory Society and European Society of Thoracic Surgeons guidance, as reported: at least 4 sensitive tissue stains should be used, 2 of mesothelial lineage and 2 of epithelial lineage.
  • From a cited meta-analysis of 11 studies of SMRP for mesothelioma: pooled sensitivity was 64% (95% confidence interval, 61% to 68%) and pooled specificity was 89% (95% confidence interval, 88% to 90%).
  • From a cited study by Park et al of healthy asbestos-exposed individuals and people with benign asbestos-related diseases: of 15 out of 538 patients with an abnormally elevated SMRP, none had malignant mesothelioma.
  • From a cited multicenter study by Hollevoet et al of 507 people: at 95% specificity, sensitivity was 64% for SMRP and 68% for MPF.
  • From a cited study by Creaney et al: combining SMRP, MPF and osteopontin did not improve diagnosis beyond SMRP alone.
  • The European guidelines, as quoted, stated there is no place for screening for mesothelioma.
  • The authors stated that blood biomarkers should not be used alone to diagnose mesothelioma.
  • The authors stated that evidence supports a possible role for biomarkers, especially serum SMRP, in predicting prognosis.
• The authors' conclusion: The authors concluded that a definitive diagnosis of malignant pleural mesothelioma still requires tissue examination, usually by direct thoracoscopic biopsy, combined with a panel of immunohistochemical stains. They also concluded that no blood biomarker is yet sensitive and specific enough to replace a tissue diagnosis.
• Limitations the authors state:
  • The authors noted that staging of mesothelioma was beyond the scope of the review.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Benign Asbestos Pleural Effusion, Carcinoma, Biomarker.

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