Siddiqui Momin T, Schmitt Fernando, Churg Andrew
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.
J Am Soc Cytopathol. 2019 Nov-Dec;8(6):352-361. doi: 10.1016/j.jasc.2019.07.005. Epub 2019 Aug 8.
We live in the "era" of minimally invasive procedures, molecular testing, and personalized care. Effusions have a high sensitivity and will often yield diagnostic cytological material. The companion session presented by the American Society of Cytopathology at the 2019 United States and Canadian Academy of Pathology meeting outlined our current and future projected practices in characterizing, managing, and diagnosing serous cavity fluids. In this second part, the role of theranostics and the diagnosis of malignant mesothelioma, as was discussed at the meeting, have been highlighted. In theranostics, a vast amount of data has been reported regarding the epidermal growth factor receptor and related molecules. Some studies have also reported on HER2 immunohistochemistry and fluorescence in situ hybridization. This follows the most active areas of research in targeted therapy. Furthermore, during this session, malignant mesothelioma was extensively discussed. The cytologic diagnosis of malignant mesothelioma in effusion specimens has been controversial; however, a definitive diagnosis will be possible in many cases. Radiologic information should be sought, because the radiologist can often provide a definite or very likely diagnosis of malignancy. Microscopically, high cellularity and/or numerous balls of cells or papillary groups will favor the diagnosis of mesothelioma. It is important to exclude metastatic carcinoma with a broad-spectrum carcinoma marker, of which claudin-4 has been the best, because it will not cross react with mesothelioma. BAP1 and MTAP immunohistochemistry and CDKN2A fluorescence in situ hybridization are very useful adjunctive techniques for separating benign from malignant mesothelial proliferations. The use of 2 of these approaches together will produce a sensitivity of 80% to 90% for epithelial mesotheliomas in the pleura, although the sensitivity has been lower in the peritoneal cavity.
我们生活在微创程序、分子检测和个性化医疗的“时代”。积液具有高敏感性，通常能提供诊断性细胞学材料。美国细胞病理学学会在2019年美国和加拿大病理学会会议上的配套会议概述了我们目前以及未来在浆液性腔隙液的特征描述、管理和诊断方面的预期做法。在这第二部分中，着重介绍了治疗诊断学的作用以及会议上讨论的恶性间皮瘤的诊断。在治疗诊断学方面，已经报道了大量关于表皮生长因子受体及相关分子的数据。一些研究还报道了HER2免疫组织化学和荧光原位杂交。这紧跟靶向治疗中最活跃的研究领域。此外，在本次会议期间，对恶性间皮瘤进行了广泛讨论。积液标本中恶性间皮瘤的细胞学诊断一直存在争议；然而，在许多情况下可以做出明确诊断。应寻求放射学信息，因为放射科医生通常能够对恶性肿瘤做出明确或极有可能的诊断。在显微镜下，高细胞密度和/或大量细胞球或乳头样结构有助于间皮瘤的诊断。用广谱癌标志物排除转移癌很重要，其中claudin-4是最好的，因为它不会与间皮瘤发生交叉反应。BAP1和MTAP免疫组织化学以及CDKN2A荧光原位杂交是区分良性和恶性间皮细胞增殖的非常有用的辅助技术。联合使用其中两种方法对胸膜上皮性间皮瘤的敏感性可达80%至90%，尽管在腹腔中的敏感性较低。
