Retired from Occupational Health Unit, Local Health Authority and Mesothelioma Registry of Brescia, Brescia, Italy.
Epidemiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
Tumori. 2022 Feb;108(1):26-32. doi: 10.1177/0300891620988354. Epub 2021 Mar 15.
Definition of histologic subtype of malignant pleural mesothelioma (MPM) is important for management of patients, because surgical treatment improves prognosis for patients with epithelioid but not biphasic or sarcomatoid MPM. In a series of necropsies performed in a hospital specialized for MPM diagnosis, we retrospectively investigated the accuracy of histologic diagnosis performed on pathologic specimens collected through pleural biopsies obtained at video-assisted thoracoscopic surgery (VATS) or surgery.
We reviewed histologic records of an unselected series of autopsies performed in patients with MPM employed in the Monfalcone shipyards (Northeast Italy) or living with shipyard workers from 1999 through 2017. Using necropsy results as a gold standard, we calculated sensitivity, specificity, and positive and negative predictive values of histology from VATS or surgery after combining nonepithelioid subtypes.
We retrieved necropsy records for 134 patients: 62 (46.3%) with epithelioid, 51 (38.1%) with biphasic, and 21 (15.7%) with sarcomatoid MPM. We observed good sensitivity of VATS (0.94) and surgery (0.89) in diagnosing epithelioid MPM. Conversely, specificity was low (VATS: 0.46; surgery: 0.32). Therefore, positive predictive values were also low (VATS: 0.58; surgery: 0.60). Misclassification was particularly high for biphasic MPM (three-fourths of biphasic MPM at necropsy had been classified as epithelioid at VATS or surgery).
We observed a substantial degree of misclassification between epithelioid and biphasic MPM for pleural biopsies performed during VATS. Our results suggest caution should be taken in using histologic subtype obtained from VATS in selecting patients with MPM for surgical treatment. We also observed substantial misclassification of biospecimens collected during MPM surgery.
恶性胸膜间皮瘤（MPM）的组织学亚型的定义对患者的管理很重要，因为手术治疗可改善上皮样 MPM 患者的预后，但不能改善双相型或肉瘤样 MPM 患者的预后。在一家专门诊断 MPM 的医院进行的一系列尸检中，我们回顾性调查了通过视频辅助胸腔镜手术（VATS）或手术获得的胸膜活检获得的病理标本进行组织学诊断的准确性。
我们复习了在意大利东北部的蒙法尔科（Monfalcone）造船厂工作的 MPM 患者或与造船厂工人一起生活的 MPM 患者的尸检记录（1999 年至 2017 年）。使用尸检结果作为金标准，我们将 VATS 或手术后的非上皮样亚型相结合，计算出组织学的敏感性、特异性、阳性预测值和阴性预测值。
我们检索了 134 名患者的尸检记录：62 名（46.3%）为上皮样，51 名（38.1%）为双相型，21 名（15.7%）为肉瘤样 MPM。我们观察到 VATS（0.94）和手术（0.89）诊断上皮样 MPM 的敏感性较高。相反，特异性较低（VATS：0.46；手术：0.32）。因此，阳性预测值也较低（VATS：0.58；手术：0.60）。双相型 MPM 的误诊率特别高（尸检中四分之三的双相型 MPM 在 VATS 或手术时被归类为上皮样）。
我们观察到 VATS 期间进行的胸膜活检中上皮样和双相型 MPM 之间存在很大程度的分类错误。我们的结果表明，在选择接受 MPM 手术治疗的患者时，应谨慎使用 VATS 获得的组织学亚型。我们还观察到 MPM 手术期间收集的生物标本存在很大程度的分类错误。
