Criteria That Are Sufficient To Identify Mesothelioma With High Specificity

One study is called, “Immunohistochemical reactivity in mesothelioma and adenocarcinoma: A stepwise logistic regression analysis” by Annika Dejmek, Anders Hjerpe - 1994 Acta Pathologica, Microbiologica et Immunologica Scandinavica – APMIS Volume 102, Issue 1-6, pages 255–264, January 1994. Here is an excerpt: “Histological sections from 103 malignant mesotheliomas and 43 adenocarcinoma metastases in pleural biopsies were investigated for reactivity against a panel of 11 different antibodies. The size of the material allowed the evaluation by stepwise logistic regression analysis, which selected five parameters of major importance: vimentin reactivity in epithelial cells, reactivity to low-molecular-weight keratins in fibrous cells, strong membrane accentuation of EM A reactivity, and lack of reactivity to LeuM1 and BerEp4. Three of these criteria were sufficient to identify a mesothelioma with high specificity and with a sensitivity of approximately 70%. Whilst the monoclonal anti-CEA tested was the most valuable single parameter, it did not add any diagnostic information to the combination of criteria selected by the stepwise logistic regression analysis. However, this antibody can be used to exclude most of the adenocarcinomas from further analysis with the more extensive panel.”

Another study is called, “Ectopic thymoma mimicking diffuse pleural mesothelioma: A case report” - Volume 29, Issue 4, Pages 409-410 (April 1998) by Hiroaki Fushimi, MD, Yoshiro Tanio, MD, Kiyoshi Kotoh, MD. Here is an excerpt: “Abstract - A case of ectopic thymoma of the pleura with a particular growth pattern mimicking diffuse pleural mesothelioma is reported. Diagnostic imaging showed that the pleural tumor encased the entire left lung. The specimen biopsied from the tumor was composed of lymphocytes and epithelial cells, consistent with the mixed type of thymoma. The autopsy found no evidence of a mediastinal tumor. An involuted thymus was found in the parietal pleural tissue adhered to the apex of the left lung. The thymoma was thought to originate from the ectopic thymic tissue in the parietal pleura, as a lesion independent from the primary mediastinal thymoma, and spread along the pleura like diffuse mesothelioma.

Another study is called, “Dose-Dependent Pulmonary Toxicity After Postoperative Intensity-Modulated Radiotherapy for Malignant Pleural MesotheliomaPresented at the 48th Annual Meeting of the American Society for Therapeutic and Radiation Oncology (ASTRO), Philadelphia, PA, November 5–9, 2006. - International Journal of Radiation Oncology Biology Physics - Volume 69, Issue 2 , Pages 350-357, 1 October 2007 by
David C. Rice, M.B., B.Ch. Affiliations - Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX. Here is an excerpt: “Purpose: To determine the incidence of fatal pulmonary events after extrapleural pneumonectomy and hemithoracic intensity-modulated radiotherapy (IMRT) for malignant pleural mesothelioma. Methods and Materials: We retrospectively reviewed the records of 63 consecutive patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy and IMRT at the University of Texas M. D. Anderson Cancer Center. The endpoints studied were pulmonary-related death (PRD) and non–cancer-related death within 6 months of IMRT.

Results: Of the 63 patients, 23 (37%) had died within 6 months of IMRT (10 of recurrent cancer, 6 of pulmonary causes [pneumonia in 4 and pneumonitis in 2], and 7 of other noncancer causes [pulmonary embolus in 2, sepsis after bronchopleural fistula in 1, and cause unknown but without pulmonary symptoms or recurrent disease in 4]). On univariate analysis, the factors that predicted for PRD were a lower preoperative ejection fraction (p = 0.021), absolute volume of lung spared at 10 Gy (p = 0.025), percentage of lung volume receiving e20 Gy (V20; p = 0.002), and mean lung dose (p = 0.013). On multivariate analysis, only V20 was predictive of PRD (p = 0.017; odds ratio, 1.50; 95% confidence interval, 1.08–2.08) or non–cancer-related death (p = 0.033; odds ratio, 1.21; 95% confidence interval, 1.02–1.45).

Conclusion: The results of our study have shown that fatal pulmonary toxicities were associated with radiation to the contralateral lung. V20 was the only independent determinant for risk of PRD or non–cancer-related death. The mean V20 of the non-PRD patients was considerably lower than that accepted during standard thoracic radiotherapy, implying that the V20 should be kept as low as possible after extrapleural pneumonectomy.