Diagnosis of Mesothelioma

Elliott, Daffolyn Rachael Fels; Jones, Kirk D.

doi:10.1016/j.path.2019.10.001

Cited by 34 publications

(39 citation statements)

References 67 publications

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“…In the diagnostic workup for the differential diagnosis of MM with epithelioid morphology from metastatic‐mimicking carcinomas, the application of an immunohistochemical panel is recommended, including at least 2 mesothelial and 2 pan‐carcinoma markers 2 . However, several antibodies and panels with different sensitivity and specificity have been proposed in the literature, and no gold standard has been established 4,23 …”

Section: Discussionmentioning

confidence: 99%

“…2 However, 1/1 (100) 1/1 (100) Thyroid follicular carcinoma, n = 1 1/1 (100) 1/1 (100) Bladder urothelial carcinoma, n = 1 1/1 (100) 1/1 (100) several antibodies and panels with different sensitivity and specificity have been proposed in the literature, and no gold standard has been established. 4,23 The choice of this panel should also consider the staining pattern, particularly in cytology, which favors more reliable nuclear and membranous expression over cytoplasmic staining, such as Claudin-4. In addition, because positive mesothelial markers may be expressed at a significant rate in carcinomas, [24][25][26][27] more specific negative antibodies like BAP1 may be more consistent in confirming a diagnosis of MM, as in other diagnostic settings (ie, INI1 in epithelioid sarcoma or Rb1 in high-grade neuroendocrine carcinoma).…”

Section: Discussionmentioning

confidence: 99%

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The “Brescia panel” (Claudin‐4 and BRCA‐associated protein 1) in the differential diagnosis of mesotheliomas with epithelioid features versus metastatic carcinomas

Bernardi¹,

Bizzarro²,

Pironi

et al. 2020

Cancer Cytopathology

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Background The distinction between mesothelioma with epithelioid features and metastatic carcinoma may be challenging, particularly on cytology. A novel 2‐hit Claudin‐4 and BRCA‐associated protein 1 (BAP1) panel was investigated. Methods The objective of this study was to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the panel on cytology from pleural effusions and matched biopsies, including 49 malignant mesotheliomas on cytology with 43 matched biopsies, 49 normal/reactive mesothelial proliferations, and 49 pleural metastatic carcinomas from different primaries with 21 matched pleural biopsies. The diagnostic role of the 4 categories obtained by crossing the immunostaining results was analyzed. Results Claudin‐4 strongly stained all metastatic carcinomas and tested completely negative in normal mesothelium, benign reactive mesothelial hyperplasia, and malignant mesothelioma. All normal and benign mesothelial proliferations and all carcinomas except 1 were immunoreactive for BAP1, whereas BAP1 loss was observed in 88% of malignant mesotheliomas. The expression of Claudin‐4 alone excluded all benign and malignant mesothelial growth, consistently characterizing all metastatic carcinomas. Double negativity was evident in all malignant mesotheliomas, and double positivity was observed in all metastatic carcinomas. BAP1‐positive/Claudin‐4–negative status was observed only in malignant mesotheliomas and benign mesothelial proliferations. A single metastatic anal squamous cell carcinoma had BAP1‐negative/Claudin‐4–positive staining. Conclusions Claudin‐4 expression was completely specific and sensitive for metastatic carcinoma, excluding mesothelial proliferations. BAP1 staining characterized 98% of metastatic carcinomas and 100% of benign mesothelial proliferations, whereas negativity was observed almost exclusively in mesotheliomas. This 2‐hit panel is probably the best compromise for differentiating malignant mesothelioma and metastatic carcinoma on either cytology or biopsy specimens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The “Brescia panel” (Claudin‐4 and BRCA‐associated protein 1) in the differential diagnosis of mesotheliomas with epithelioid features versus metastatic carcinomas

Bernardi¹,

Bizzarro²,

Pironi

et al. 2020

Cancer Cytopathology

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“…However, definitive diagnosis is by biopsy, which can be guided by radiology (CT) or surgery. MPM includes three histologic subtypes: epithelioid (as seen in our case), sarcomatous, and biphasic [1][2][3][4][5][6][7]. There is no uniformly accepted classification system for MPM.…”

Section: Discussionmentioning

confidence: 99%

“Omental Cake” in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma

Martínez

Guerrero

Gonzaga

2021

Cureus

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“…Affirmative markers used in the evaluation of epithelioid MPM are of limited utility in sarcomatoid tumours. More usefully, cytokeratin markers, such as CAM5.2, are important in differentiating sarcomatoid MPM (positive staining) from sarcoma, which is usually keratin-negative [43]. D2-40 (podoplanin) can be used to differentiate sarcomatoid MPM from pulmonary sarcomatoid carcinoma (which also stains positively for TTF1, napsin and p40/p63).…”

Section: Distinguishing Mesothelioma From Other Malignant Cell Neoplasmsmentioning

confidence: 99%

Ancillary Diagnostic Investigations in Malignant Pleural Mesothelioma

Dipper

Maskell

Bibby

2021

Cancers

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For a number of patients presenting with an undiagnosed pleural effusion, frailty, medical co-morbidity or personal choice may preclude the use of pleural biopsy, the gold standard investigation for diagnosis of malignant pleural mesothelioma (MPM). In this review article, we outline the most recent evidence on ancillary diagnostic tests which may be used to support a diagnosis of MPM where histological samples cannot be obtained or where results are non-diagnostic. Immunocytochemical markers, molecular techniques, diagnostic biomarkers and imaging techniques are discussed. No adjunctive test has a sensitivity and specificity profile to support use in isolation; however, correlation of pleural fluid cytology with relevant radiology and supplementary biomarkers can enable an MDT-consensus clinico-radiological-cytological diagnosis to be made where further invasive tests are not possible or not appropriate. Diagnostic challenges surrounding non-epithelioid MPM are recognised, and there is a critical need for reliable and non-invasive investigative tools in this population.

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Diagnosis of Mesothelioma

Cited by 34 publications

References 67 publications

The “Brescia panel” (Claudin‐4 and BRCA‐associated protein 1) in the differential diagnosis of mesotheliomas with epithelioid features versus metastatic carcinomas

The “Brescia panel” (Claudin‐4 and BRCA‐associated protein 1) in the differential diagnosis of mesotheliomas with epithelioid features versus metastatic carcinomas

“Omental Cake” in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma

Ancillary Diagnostic Investigations in Malignant Pleural Mesothelioma

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