1
|
Miller LJ, Holmes IM, Lew M. An Updated Contextual Approach to Mesothelial Proliferations in Pleural Effusion Cytology Leveraging Morphology, Ancillary Studies, and Novel Biomarkers. Arch Pathol Lab Med 2024; 148:409-418. [PMID: 37622452 DOI: 10.5858/arpa.2023-0049-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT.— Pleural effusions are common cytologic specimens that can be leveraged to make diagnoses of malignancy that drive appropriate patient management. However, the overlap in morphologic features of reactive mesothelial proliferations, mesotheliomas, and adenocarcinomas can create diagnostic pitfalls in the cytologic evaluation of pleural fluids. OBJECTIVE.— To review the morphologic spectrum of benign and malignant mesothelial proliferations in pleural effusions, as well as relevant clinicoradiologic contexts and ancillary tests. DATA SOURCES.— Existing scientific and clinical literature as of January 2023. CONCLUSIONS.— We can leverage the knowledge of several overlapping morphologic features, clinicoradiologic scenarios, and immunohistochemical studies to enhance the diagnostic accuracy of pleural effusion cytology to appropriately delineate cases of adenocarcinoma, reactive mesothelial proliferation, and mesothelioma. Earlier diagnosis through cytology, particularly in cases of mesothelioma, may positively impact patient treatment options and prognosis.
Collapse
Affiliation(s)
- Lauren J Miller
- From the Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor
| | - Isabella M Holmes
- From the Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor
| | - Madelyn Lew
- From the Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor
| |
Collapse
|
2
|
Li Y, Salama AM, Baine MK, Bodd FM, Offin MD, Rekhtman N, Zauderer MG, Travis WD, Adusumilli PS, Sauter JL. Reliability of assessing morphologic features with prognostic significance in cytology specimens of epithelioid diffuse pleural mesothelioma and implications for cytopathology reporting. Cancer Cytopathol 2023; 131:495-506. [PMID: 37127928 PMCID: PMC11037265 DOI: 10.1002/cncy.22705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The World Health Organization incorporates morphologic features with prognostic significance in the 2021 classification of epithelioid diffuse pleural mesothelioma (E-DPM). Although cytology specimens are often the first and occasionally the only specimen available for patients with DPM, these features have not yet been investigated in cytology. METHODS Nuclear atypia, pleomorphic features, necrosis, and architectural patterns were retrospectively assessed in 35 paired cytology and concurrent/consecutive surgical pathology specimens of E-DPM. Agreement between pairs was determined via unweighted κ scores. Discordant cases were re-reviewed to determine the reasons for disagreement. RESULTS Interpretation of nuclear atypia in cytology was concordant with histology in all cases (κ = 1.000; p < .001). The presence of pleomorphic features and necrosis was concordant in 97.1% (κ = 0.842; p < .001) and 85.7% (κ = 0.481; p = .001) of paired cases, respectively. Assessment of architectural patterns in cytology showed only slight agreement with histology (κ = 0.127; p = .037). In cytology cases (n = 23) with cell block material available, assessment of nuclear atypia and the presence of pleomorphic features showed perfect agreement (κ = 1.000; p < .001, each), the presence of necrosis showed moderate agreement (κ = 0.465; p = .008), and assessment of architectural patterns showed slight agreement (κ = 0.162; p = .15) in paired specimens. Most disagreements were due to sampling differences between cytology and histology specimens. CONCLUSIONS Although complete nuclear grading of E-DPM is not possible given the unreliability of mitotic counts in cytology, assessment of nuclear atypia in cytology specimens is shown to be reliable. Identification of pleomorphic features and necrosis is also reliable despite occasional sampling issues. Assessment of architectural patterns is more limited in cytology.
Collapse
Affiliation(s)
- Yan Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Hubei, People’s Republic of China
| | - Abeer M. Salama
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Marina K Baine
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Francis M. Bodd
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Michael D. Offin
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, and Department of Medicine, Weill Cornell Medical College, New York, New York, 10065, USA
| | - Natasha Rekhtman
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Marjorie G. Zauderer
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, and Department of Medicine, Weill Cornell Medical College, New York, New York, 10065, USA
| | - William D. Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Jennifer L. Sauter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| |
Collapse
|
3
|
Hjerpe A, Demir E, Abd-Own S, Dobra K. Utility of BerEp4/calretinin and desmin/epithelial membrane antigen (EMA) dual immunocytochemical staining in effusion cytology. Cancer Med 2023; 12:5334-5340. [PMID: 36259232 PMCID: PMC10028146 DOI: 10.1002/cam4.5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is typically diagnosed late during the disease. Earlier detection can increase the chance of effective therapy. Recurrent pleural effusions are the earliest symptoms displaying an array of cytomorphological changes from reactive atypia to malignancy. Diagnosis is possible on effusion cytology by applying molecular and immunocytochemical markers, the main difficulty being when to suspect PM and to differentiate PM from metastatic adenocarcinoma and reactive mesothelial proliferations. METHODS We evaluated the diagnostic performance of two immunocytochemical dual stains (BerEp4/Calretinin and Desmin/Epithelial Membrane Antigen (EMA)) on 149 ethanol-fixed cytospin preparation as an initial step to solve the mentioned diagnostic difficulty. The immunocytochemical reactivity pattern was evaluated by two independent investigators. The final diagnosis corresponded to PM (n = 20), metastatic adenocarcinoma (n = 83), and mesotheliosis (n = 46) in these cases. RESULTS Calretinin had 99% specificity and 98% sensitivity for indicating a mesothelial phenotype, while BerEp4 distinguished the adenocarcinoma cases with 98% specificity and 99% sensitivity. EMA displayed 96% specificity and 99% sensitivity in malignant cases, while Desmin without EMA present showed 99% specificity and 96% sensitivity for indicating benign mesothelial proliferation. CONCLUSIONS Interpretation of the four immunoreactions is improved when performed as dual stains. The dual staining is a useful tool in the initial handling of atypical effusions and guides the subsequent choice of antibody panels for more detailed subclassification of malignant effusions.
Collapse
Affiliation(s)
- Anders Hjerpe
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Enes Demir
- Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sulaf Abd-Own
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katalin Dobra
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Ak G, Metintas S, Taskın AN, Uzel Sener M, Soyler Y, Yilmaz M, Turna A, Akin Kabalak P, Bilaceroglu S, Koksal D, Yilmaz Demirci N, Sogukpinar O, Boga S, Ercelik M, Karadeniz G, Polat G, Guldaval F, Aka Akturk U, Yilmaz S, Ogan N, Yilmaz S, Esendagli D, Caglayan B, Zeybek A, Durmus Kocak N, Mutlu P, Atinkaya Baytemir C, Sarbay I, Yilmaz U, Metintas M. Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study. Lung 2022; 200:807-815. [PMID: 36173482 DOI: 10.1007/s00408-022-00573-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. METHODS This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. RESULTS The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). CONCLUSION The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.
Collapse
Affiliation(s)
- Guntulu Ak
- Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Selma Metintas
- Medical Faculty, Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ayse Naz Taskın
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Melahat Uzel Sener
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Yasemin Soyler
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Meltem Yilmaz
- Medical Faculty, Department of Chest Diseases, Namik Kemal University, Tekirdaǧ, Turkey
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pınar Akin Kabalak
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Semra Bilaceroglu
- Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Deniz Koksal
- Medical Faculty, Department of Chest Diseases, Hacettepe University, Ankara, Turkey
| | | | - Ozlem Sogukpinar
- Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sibel Boga
- Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Merve Ercelik
- Medical Faculty, Department of Chest Diseases, Duzce University, Duzce, Turkey
| | - Gulistan Karadeniz
- Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Gulru Polat
- Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Filiz Guldaval
- Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ulku Aka Akturk
- Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Senay Yilmaz
- Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nalan Ogan
- Medical Faculty, Department of Chest Diseases, Ufuk University, Ankara, Turkey
| | - Saliha Yilmaz
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Dorina Esendagli
- Medical Faculty, Department of Chest Diseases, Baskent University, Ankara, Turkey
| | - Benan Caglayan
- Medical Faculty, Department of Chest Diseases, Koc University, Istanbul, Turkey
| | - Arife Zeybek
- Medical Faculty, Department of Thoracic Surgery, Mugla Sitki Kocman University, Mugla, Turkey
| | - Nagihan Durmus Kocak
- Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Pinar Mutlu
- Medical Faculty, Department of Chest Diseases, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Cansel Atinkaya Baytemir
- Hamidiye Faculty of Medicine, Department of Thoracic Surgery, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ismail Sarbay
- Department of Thoracic Surgery, Cerrahpasa Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ulku Yilmaz
- Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Muzaffer Metintas
- Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
5
|
Mansour MSI, Seidal T, Mager U, Dobra K, Brunnström H, Dejmek A. Higher concordance of PD-L1 expression between biopsies and effusions in epithelioid than in nonepithelioid pleural mesothelioma. Cancer Cytopathol 2021; 129:468-478. [PMID: 33493383 PMCID: PMC8248121 DOI: 10.1002/cncy.22401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant mesothelioma (MM) is a therapy-resistant tumor, often causing an effusion. Drugs targeting the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway have shown promising results, but assessment of PD-L1 expression to select patients for therapy has mainly been performed on histologic tissue samples. In a previous study, we showed that MM effusions are suitable for PD-L1 assessment with results comparable to those reported in histologic studies, but no studies have compared PD-L1 expression in histologic and cytologic samples. METHODS PD-L1 expression was determined immunohistochemically (clone 28-8) in 61 paired samples of effusions and biopsies from patients with pleural MM, obtained at the time of diagnosis. Only cases with >100 tumor cells were included. Membranous staining in tumor cells was considered positive at ≥1%, >5%, >10%, and >50% cutoff levels. RESULTS Of 61 histologic samples, PD-L1 expression was found in 28 and 7 samples at ≥1% and >50% cutoffs, respectively; the corresponding figures for cytology were 21 and 5, respectively. The overall percentage agreement between histology and cytology was 69% and 84%, with a kappa (κ) of 0.36 and 0.08 at ≥1% and >50% cutoffs, respectively. The concordance between cytology and histology tended to be higher for epithelioid MM versus nonepithelioid MM at a ≥1% cutoff. PD-L1 positivity in biopsies, but not in effusions, correlated with the histologic subtype at a ≥1% cutoff. CONCLUSIONS A moderate concordance of PD-L1 expression between biopsies and effusions from pleural MM, especially for the epithelioid subtype, indicates biological differences between the 2 types of specimens. Cytology and histology may be complementary.
Collapse
Affiliation(s)
- Mohammed S. I. Mansour
- Department of Pathology and CytologyHalland Hospital HalmstadHalmstadSweden
- Division of PathologyDepartment of Clinical Sciences LundLund UniversityLundSweden
| | - Tomas Seidal
- Department of Pathology and CytologyHalland Hospital HalmstadHalmstadSweden
| | - Ulrich Mager
- Division of Respiratory and Internal MedicineDepartment of Clinical MedicineHalland Hospital HalmstadHalmstadSweden
| | - Katalin Dobra
- Division of Clinical Pathology/CytologyDepartment of Laboratory MedicineKarolinska InstituteKarolinska University Hospital HuddingeHuddingeSweden
| | - Hans Brunnström
- Division of PathologyDepartment of Clinical Sciences LundLund UniversityLundSweden
- Department of Genetics and PathologyLaboratory Medicine Region SkåneLundSweden
| | - Annika Dejmek
- Department of Translational Medicine in MalmöLund UniversityMalmöSweden
| |
Collapse
|
6
|
Michael CW. Serous fluid cytopathology: Past, present, and future. Diagn Cytopathol 2021; 49:577-581. [PMID: 33634959 DOI: 10.1002/dc.24663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022]
Abstract
Serous fluids/effusions are common cytology samples that reflect a wide range of diseases and lend themselves to a multitude of investigations that include microscopy, chemical analysis, cell count, cultures, and analysis for biomarkers and immunomarkers. In recent years, effusions have also served as a liquid biopsy that can be interrogated by molecular tests for thoranostic and prognostic markers and selection of targeted therapy. The recently published International Reporting System for Serous Fluid Cytopathology (IRSSF) provides a standardized reporting terminology with well- defined diagnostic criteria. This editorial provides a global review of the progress in the work-up of effusions and a summary of the IRSSF book and its most significant contributions. The editorial also includes a summary of the diagnostic categories including their definition and the significant relevant information.
Collapse
Affiliation(s)
- Claire W Michael
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Kaur K, Patel T, Samanta S, Patra S, Trivedi P. Role of Cytology in the Current Guidelines for Malignant Mesothelioma: Largest Study from India. Acta Cytol 2020; 65:175-185. [PMID: 33316798 DOI: 10.1159/000512011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cytology provides crucial window for early diagnosis of malignant mesothelioma (MM) since it is often the first and easily available material for evaluation, resulting in early treatment. Still, its role is overlooked in the current treatment guidelines. The aim of this study is to determine the sensitivity of cytomorphology and role of subsequent ancillary techniques in diagnosing MM. METHODS This is a 5-year retrospective analysis of MM in the tertiary oncology center to determine sensitivity of cytomorphology and subsequent role of immunohistochemistry (IHC) in final diagnosis of MM according to the guidelines for cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma (GCDMM) laid by International Mesothelioma Interest Group. Cytomorphology and immunocytochemistry from effusions and fine needle aspirations were analyzed. RESULTS Sixty-two of 128 cases of MM had cytology and cytomorphological criteria described in GCDMM were fulfilled in 61.3% cases. Architectural atypia was useful in identifying cases with low cytological atypia. Overall sensitivity of cytomorphology was 73.01%. Sensitivity of effusion cytology was 77.8%. Subsequent IHC on cell blocks revealed the sensitivity as 100% for mesothelin, calretinin, and cytokeratin 5/6; 87.5% for thrombomodulin; and 50% for WT1, while CEA and TTF1 showed 100% specificity. Treatment was given based on final diagnosis of MM given after IHC on cytology material in only 25.8% cases. However, it was possible in additional 35.5% cases. Mean survival was 10 months when diagnosed by cytology, compared to 7 months by histology. CONCLUSIONS Rather than ignoring the role of cytology in the diagnosis and treatment guidelines for MM, it is important to understand its strengths and limitations. Standardized guidelines in future can play an important role in more streamlined communication between cytopathologist and clinician.
Collapse
Affiliation(s)
- Kanwalpreet Kaur
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Trupti Patel
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India,
| | - Satrupa Samanta
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Sanjiban Patra
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Priti Trivedi
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| |
Collapse
|
8
|
Javadi J, Dobra K, Hjerpe A. Multiplex Soluble Biomarker Analysis from Pleural Effusion. Biomolecules 2020; 10:biom10081113. [PMID: 32731396 PMCID: PMC7464384 DOI: 10.3390/biom10081113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a highly aggressive and therapy resistant pleural malignancy that is caused by asbestos exposure. MPM is associated with poor prognosis and a short patient survival. The survival time is strongly influenced by the subtype of the tumor. Dyspnea and accumulation of pleural effusion in the pleural cavity are common symptoms of MPM. The diagnostic distinction from other malignancies and reactive conditions is done using histopathology or cytopathology, always supported by immunohistochemistry, and sometimes also by analyses of soluble biomarkers in effusion supernatant. We evaluated the soluble angiogenesis related molecules as possible prognostic and diagnostic biomarkers for MPM by Luminex multiplex assay. Pleural effusion from 42 patients with malignant pleural mesothelioma (MPM), 36 patients with adenocarcinoma (AD) and 40 benign (BE) effusions were analyzed for 10 different analytes that, in previous studies, were associated with angiogenesis, consisting of Angiopoietin-1, HGF, MMP-7, Osteopontin, TIMP-1, Galectin, Mesothelin, NRG1-b1, Syndecan-1 (SDC-1) and VEGF by a Human Premixed Multi-Analyte Luminex kit. We found that shed SDC-1 and MMP-7 levels were significantly lower, whereas Mesothelin and Galectin-1 levels were significantly higher in malignant mesothelioma effusions, compared to adenocarcinoma. Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1, NRG1-β1, VEGF and TIMP-1 were significantly higher in malignant pleural mesothelioma effusions compared to benign samples. Moreover, there is a negative correlation between Mesothelin and shed SDC-1 and positive correlation between VEGF, Angiopoietin-1 and shed SDC-1 level in the pleural effusion from malignant cases. Shed SDC-1 and VEGF have a prognostic value in malignant mesothelioma patients. Collectively, our data suggest that MMP-7, shed SDC-1, Mesothelin and Galectin-1 can be diagnostic and VEGF and SDC-1 prognostic markers in MPM patients. Additionally, Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1 and TIMP-1 can be diagnostic for malignant cases.
Collapse
Affiliation(s)
- Joman Javadi
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Huddinge University Hospital, SE-14186 Stockholm, Sweden;
- Correspondence: ; Tel.: +46-762-615-122
| | - Katalin Dobra
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Huddinge University Hospital, SE-14186 Stockholm, Sweden;
- Karolinska University Hospital, Karolinska University laboratory, Huddinge University Hospital, SE-14186 Stockholm, Sweden;
| | - Anders Hjerpe
- Karolinska University Hospital, Karolinska University laboratory, Huddinge University Hospital, SE-14186 Stockholm, Sweden;
| |
Collapse
|
9
|
Hjerpe A, Abd Own S, Dobra K. Integrative approach to cytologic and molecular diagnosis of malignant pleural mesothelioma. Transl Lung Cancer Res 2020; 9:934-943. [PMID: 32676359 PMCID: PMC7354145 DOI: 10.21037/tlcr-2019-pps-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The global incidence of malignant mesothelioma (MM) causes considerable disease burden, suffering and health care costs. Beside preventive measures and ban the use of asbestos, early diagnosis would largely improve the chance of curative treatment. Current histologic criteria, however, requiring presence of invasion in the surrounding fatty tissue fail to identify MM in sufficiently early stage. Unilateral accumulation of pleural effusion is one of the earliest clinical manifestations of MM that occurs in approximately 90% of the patients. Therapeutic thoracocenthesis is necessary to remove the fluid and to relieve patients’ symptoms. This effusion is easily accessible and offers early and minimally invasive diagnosis by combining cytology with immunologic, molecular- and biomarker analyses. Typically, the fluid is rich in malignant cells and cell groups, but incipient stages of the disease may be difficult to recognize as the malignant cells can be masked by presence of inflammatory or reactive mesothelial cells. Recurrent, hemorrhagic and cell rich effusion should always be suspicious for MM and adequately prepared and analyzed to provide necessary information for subsequent therapy. Importantly, early detection of MM by integrating cytology and molecular approaches has high sensitivity and positive predictive value and has a major impact on patient survival. Thus, a conclusive positive MM cytology should lead to treatment without delay. This review summarizes molecular and diagnostic criteria of MM diagnosis.
Collapse
Affiliation(s)
- Anders Hjerpe
- Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sulaf Abd Own
- Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Katalin Dobra
- Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|