Cytological diagnosis of malignant pleural mesothelioma
- Current Pulmonology Reports
Authors: Siaw Ming Chai, Chris Van Vliet
Publisher: Springer US
Purpose of review
Advances in the pathology and genetics of malignant pleural mesothelioma (MPM) have impacted upon cytology diagnosis. Cytological diagnosis can, in many cases, negate the need for more invasive diagnostic procedures in patients with epithelioid and mixed-type MPM with implications for patient morbidity and health care expenditure.
The diagnostic accuracy of effusion cytology is enhanced by a standardised approach to sample preparation, allowing optimal microscopy, immunohistochemistry (IHC), fluorescent in situ hybridisation (FISH) and other molecular analyses. Loss of BRCA1-associated protein 1 (BAP1) by IHC has emerged as a highly specific marker of mesothelial malignancy. When combined with other ancillary techniques such as FISH for CDKN2a(p16), 100% specificity for malignant mesothelioma can be achieved even in challenging cases, albeit with lower sensitivity.
Current effusion diagnosis of MPM is highly sensitive and specific. Alterations in BAP1 and CDKN2a(p16) are not only promising as diagnostic tests but may also have prognostic implications.