British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

Guidelines for the cytopathologic diagnosis of epithelioid and mixed‐type malignant mesothelioma: Complementary statement from the international mesothelioma interest group, also endorsed by the international academy of cytology and the papanicolaou society of cytopathology. A proposal to be applauded and promoted but which requires updating

“…The latter raises the issue of utilising central/expert review in difficult cases although this is not developed in the guidelines. The GCDMM guidelines suggest that histology is necessary to “reinforce the suspicion (of mesothelioma)” only this seems to contradict the most recent British Thoracic Society (BTS) statement on mesothelioma which states that cytology in mesothelioma is a “controversial subject” and even the main IMIG guidelines on mesothelioma seem to come at things from the reverse direction stating, “Do not rely on cytology alone to make a diagnosis of MPM (malignant pleural mesothelioma) unless biopsy is not possible or not required to determine treatment due to patient wishes or poor PS (performance score)” and the BTS statement says “The diagnosis of MM should always be based on the results obtained from an adequate biopsy (less commonly, an exfoliative or fine‐needle aspiration cytology evaluation) in the context of appropriate clinical, radiologic, and surgical findings.” Further education and realignment appears to be required here with consistency between IMIG groups and the wider clinical thoracic oncology community.…”

Epithelial cell adhesion molecule (EpCAM) from pleural fluid cell lysates is a highly accurate diagnostic biomarker of adenocarcinomatous effusions

“…ICC markers, usually performed on PF cell blocks (CB), assist in the challenging differential diagnosis between reactive mesothelial cells, metastatic carcinomas and mesotheliomas . Of those, epithelial cell adhesion molecule (EpCAM) and claudin 4 (CL4) are considered to be suitable carcinoma markers and are regularly integrated in the recommended ICC panels . More recently, positive immunoreactivity for human epididymis protein 4 (HE4) has been found in a number of epithelial malignancies, especially in ovarian and lung tumours .…”

Advances in pulmonary and pleural malignant disorders

“…1 Five-year survival rates for malignant mesothelioma are similarly poor, between 5% and 10%, with median survival between 12 to 21 months for stage 4 and stage 1 disease, respectively. 3 However, with the development of targeted therapy and immunotherapy it is likely that the survival will improve. Overall, around 90% of cases of lung cancer are caused by tobacco smoking.…”