Improving the Accuracy of Mesothelioma Diagnosis in China

Abstract

Background In the Western World malignant mesothelioma (MM) is most prevalent in the pleura of older males professionally exposed to asbestos. Information about MM from rapidly industrializing countries, such as China, is minimal. There is concern that a proportion of MM diagnoses in China may be incorrect because most Chinese physicians do not have experience diagnosing this rare cancer. We recently reported an unusual high incidence of peritoneal MM among Eastern Chinese female patients. Here, we review the accuracy of MM diagnoses in China and provide suggestions to improve the accuracy of diagnosis. Methods We reviewed 92 pathological diagnosis of MM during 2002–2015 from two reference centers in the province of Zhejiang, Eastern China. We performed, a large set of immunohistochemical (IHC) analyses to increase the reliability of the diagnosis. Results We confirmed the MM diagnosis in 12/34 (35.3%) of the pleural tumors, in 38/56 (67.9%) of the peritoneal tumors, and in 2/2 (100%) of the MM of the tunica vaginalis. MM were characterized by tumor cells showing nuclear WT1 and calretinin staining and by strong membranous staining for cytokeratin (CK) CAM5.2. The epithelial markers, CEA, TTF1, MOC31, BerEP4, p63, p40, PAX8, ER and PR were negative. BAP1 nuclear staining was lost in percentages similar to what reported for samples from Western countries. Conclusions Our findings suggest that MM –especially in its pleural localization– is often misdiagnosed in Eastern China. Identifying pitfalls and possible solutions in the pathological diagnosis of MM will impact both standard of care and research in China.

Incidence of malignancy and survival in patients with idiopathic pleuritis

“…This may suggest that VATS have superior sensitivity to pleuroscopy in ruling out malignancy in pleural effusions of unknown origin (7,14). However, inter-center differences in experience of thoracoscopists and/or pathologists might also be of importance (15). No prospective studies so far have compared the sensitivity of pleuroscopy and VATS.…”

Mesothelioma: recent highlights

“…The most specific marker for mesothelioma is WT1. However, for peritoneal mesotheliomas in women, WT1 is not helpful as it stains ovarian cancers; instead ER and PR staining should be used (4,5).…”

“…As we were reviewing the accuracy of the diagnoses of mesothelioma in Eastern China (5,52) in mesotheliomas linked to inherited germline BAP1 mutations, to environmental exposure occurring since birth, radiation or to other yet unknown carcinogens (13,39). In the absence of occupational asbestos exposure, the expected M:F ratio is close to 1:1 (12).…”

Diagnostic and prognostic biomarkers for malignant mesothelioma: an update

“…In France, the accuracy of initial diagnosis of MM was reported only in 67% of cases (23). We recently reviewed 92 pathological diagnoses of MM from China and found that the diagnostic accuracy rate was about 56.6% (24). In our experience, there are about 1/10 cases of MMs misdiagnosed in the US.…”