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Reproducibility of histological subtyping of malignant pleural mesothelioma

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Abstract

Malignant pleural mesothelioma (MPM) has a very poor prognosis. Although clinical stage is currently the only reliable prognostic factor, histologic subtyping reportedly also affects prognosis. Some studies propose reclassification of pleomorphic epithelioid as biphasic or sarcomatoid MPM. This study assessed prognostic significance and interobserver agreement in MPM subtyping of small biopsy specimens. We analyzed biopsy specimens, and clinical and survival data from records of 108 patients who were diagnosed between 2000 and 2010 at the Institute of Pathology University of Zagreb School of Medicine, of whom 98 had epithelioid MPM, six biphasic MPM, and four sarcomatoid MPM. Among epithelioid subtypes, 44 (44.9 %) were solid, 19 (19.4 %) tubulopapillary, 18 (18.4 %) acinar, six (6.1 %) adenomatoid, five (5.1 %) pleomorphic, four (4.1 %) trabecular, and two (2.0 %) micropapillary subtype. Interobserver reliability for histological diagnosis was found to be κ = 0.72 (P < 0.001). Median overall survival for epithelioid MPM was 10.5 months with an interquartile range (IQR) of 5.8–28.0 months but significantly shorter for the pleomorphic subtype (3 [IQR 3.0–8.0] months; P = 0.034), but not significantly different from biphasic (6.5 [IQR 3.5–15.3] months) and sarcomatoid mesothelioma (4.0 [IQR 1.3–6.8] months; P = 0.270). We found strong reproducibility of MPM subtyping with good interobserver agreement. Furthermore, our results indicate that pleomorphic subtype to be a predictor of poor prognosis and support classifying it with sarcomatoid or biphasic MPM, as patients with the pleomorphic, biphasic, or sarcomatoid subtype show similarly poor overall survival.

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References

  1. Robinson BWS, Lake RA (2005) Advances in malignant mesothelioma. N Engl J Med 353:1591–1603

    Article  CAS  PubMed  Google Scholar 

  2. Oviedo SP, Cagle PT (2012) Diffuse malignant mesothelioma. Arch Pathol Lab Med 136:882–888

    Article  PubMed  Google Scholar 

  3. Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, DeCamp MM Jr, Swanson SJ, Bueno R, Lukanich JM, Baldini EH, Mentzer SJ (1999) Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results of 183 patients. J Thorac Cardiovasc Surg 117:54–65

    Article  CAS  PubMed  Google Scholar 

  4. Flores RM, Zakowski M, Venkatraman E, Krug L, Rosenzweig K, Dycoco J, Lee C, Yeoh C, Bains M, Rusch V (2007) Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol 2:957–965

    Article  PubMed  Google Scholar 

  5. Bille A, Belcher E, Raubenheimer H et al (2012) Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy’s and St Thomas’ hospitals. Gen Thorac Cardiovasc Surg 60:289–296

    Article  PubMed  Google Scholar 

  6. Tracey E, Kerr T, Dobrovic A, Currow D (2010) Cancer in NSW: incidence and mortality report 2008. Cancer Institute NSW, Sydney

    Google Scholar 

  7. Neumann V, Günthe S, Mülle KM, Fischer M (2001) Malignant mesothelioma—German mesothelioma register 1987–1999. Int Arch Occup Environ Health 74:383–395

    Article  CAS  PubMed  Google Scholar 

  8. Rusch VW, Giroux D, Kennedy C, Ruffini E, Cangir AK, Rice D, Pass H, Asamura H, Waller D, Edwards J, Weder W, Hoffmann H, van Meerbeeck JP, Staging Committee IASLC (2012) Initial analysis of the International Association for the Study of Lung Cancer Mesothelioma database. J Thorac Oncol 7:1631–1639

    Article  PubMed  Google Scholar 

  9. Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC (2004) Pathology and genetics of tumours of the lung pleura thymus and heart. ARC Press, Lyon

    Google Scholar 

  10. Henderson DW, Reid G, Kao SC, van Zandwijk N, Klebe S (2013) Challenges and controversies in the diagnosis of malignant mesothelioma: part 2. Malignant mesothelioma subtypes, pleural synovial sarcoma, molecular and prognostic aspects of mesothelioma, BAP1, aquaporin-1 and microRNA. J Clin Pathol 66:854–861

    Article  PubMed  Google Scholar 

  11. Kadota K, Suzuki K, Sima CS, Rusch VW, Adusumilli PS, Travis WD (2011) Pleomorphic epithelioid diffuse malignant pleural mesothelioma: a clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma. J Thora Oncol 6:896–904

    Article  Google Scholar 

  12. Ordóñez NG (2012) Pleomorphic mesothelioma: report of 10 cases. Mod Pathol 25:1011–1022

    Article  PubMed  Google Scholar 

  13. International Mesothelioma Interest Group, Husain AN, Colby T, Ordonez N, Krausz T, Attanoos R, Beasley MB, Borczuk AC, Butnor K, Cagle PT, Chirieac LR, Churg A, Dacic S, Fraire A, Galateau-Salle F, Gibbs A, Gown A, Hammar S, Litzky L, Marchevsky AM, Nicholson AG, Roggli V, Travis WD, Wick M (2013) Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 137:647–667

    Article  PubMed  Google Scholar 

  14. Allen TC (2005) Recognition of histopathologic patterns of diffuse malignant mesothelioma in differential diagnosis of pleural biopsies. Arch Pathol Lab Med 129:1415–1420

    PubMed  Google Scholar 

  15. Shia J, Qin J, Erlandson RA, King R, Illei P, Nobrega J, Yao D, Klimstra DS (2005) Malignant mesothelioma with a pronounced myxoid stroma: a clinical and pathological evaluation of 19 cases. Virchows Arch 447:828–834

    Article  PubMed  Google Scholar 

  16. Pass HI (2012) Biomarkers and prognostic factors for mesothelioma. Ann Cardiothorac Surg 1:449–456

    PubMed Central  PubMed  Google Scholar 

  17. Orvieto E, Maiorano E, Bottiglieri L, Maisonneuve P, Rotmensz N, Galimberti V, Luini A, Brenelli F, Gatti G, Viale G (2008) Clinicopathologic characteristics of invasive lobular carcinoma of the breast. Cancer 113:1511–1520

    Article  PubMed  Google Scholar 

  18. Motoi N, Szoke J, Riely GJ, Seshan VE, Kris MG, Rusch VW, Gerald WL, Travis WD (2008) Lung adenocarcinoma: modification of the 2004 WHO mixed subtype to include the major histologic subtype suggests correlations between papillary and micropapillary adenocarcinoma subtypes, EGFR mutations and gene expression analysis. Am J Surg Pathol 32:810–827

    Article  PubMed  Google Scholar 

  19. Solcia E, Klersy C, Mastracci L, Alberizzi P, Candusso ME, Diegoli M, Tava F, Riboni R, Manca R, Luinetti O (2009) A combined histologic and molecular approach identifies three groups of gastric cancer with different prognosis. Virchows Arch 455:197–211

    Article  CAS  PubMed  Google Scholar 

  20. Chiaravalli AM, Klersy C, Tava F, Manca R, Fiocca R, Capella C, Solcia E (2009) Lower- and higher-grade subtypes of diffuse gastric cancer. Hum Pathol 40:1591–1599

    Article  CAS  PubMed  Google Scholar 

  21. Reeves GK, Pirie K, Green J, Bull D, Beral V, Million Women Study Collaborators (2009) Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis. Br J Cancer 100:538–544

    Article  Google Scholar 

  22. Okudela K, Woo T, Mitsui H, Yazawa T, Shimoyamada H, Tajiri M, Ogawa N, Masuda M, Kitamura H (2010) Morphometric profiling of lung cancers. Its association with clinicopathologic, biologic, and molecular genetic features. Am J Surg Pathol 34:243–255

    Article  PubMed  Google Scholar 

  23. Travis WD, Brambilla E, Noguchi M et al (2011) International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285

    Article  PubMed  Google Scholar 

  24. Greillier L, Cavailles A, Fraticelli A, Scherpereel A, Barlesi F, Tassi G, Thomas P, Astoul P (2007) Accuracy of pleural biopsy using thoracoscopy for the diagnosis of histologic subtype in patients with malignant pleural mesothelioma. Cancer 110:2248–2252

    Article  PubMed  Google Scholar 

  25. Arrossi AV, Lin E, Rice D, Moran CA (2008) Histologic assessment and prognostic factors of malignant pleural mesothelioma treated with extrapleural pneumonectomy. Am J Clin Pathol 130:754–764

    Article  PubMed  Google Scholar 

  26. Galateau-Salle F, Le Stang N, Astoul P, Brochard P, Pairon JC, Gilg Soit Ilg A, Imbernon E, Goldberg M (2010) Malignant mesothelioma of the pleura with pleomorphic features: a series of 44 cases. Modern Pathol 23:402A

    Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute of Pathology, University of Zagreb School of Medicine, Salata 10, 10000, Zagreb, Croatia

    Luka Brčić, Vlasta Klarić, Ana Šepac & Sven Seiwerth

  2. Clinical Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia

    Luka Brčić, Iva Brčić & Sven Seiwerth

  3. Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Marko Jakopović & Miroslav Samaržija

  4. Department for Occupational and Occupational Health, Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia

    Milan Milošević

Authors
  1. Luka Brčić
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  2. Marko Jakopović
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  3. Iva Brčić
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Correspondence to Luka Brčić.

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Brčić, L., Jakopović, M., Brčić, I. et al. Reproducibility of histological subtyping of malignant pleural mesothelioma. Virchows Arch 465, 679–685 (2014). https://doi.org/10.1007/s00428-014-1664-9

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  • DOI: https://doi.org/10.1007/s00428-014-1664-9

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