Two medical organizations recently discussed the current procedure for diagnosing mesothelioma.
The result was new recommendations about how specialists should report findings from a mesothelioma tissue biopsy. There are also recommendations regarding which types of patients should receive certain treatments.
The European Network for Rare Adult Solid Cancers (EURACAN) and the International Association for the Study of Lung Cancer (IASLC) submitted a joint analysis regarding the topic. They titled it, “proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach.”
The group includes pathologists, molecular biologists, surgeons, radiologists and oncologists. They met in 2018 but just released the new recommendations last month.
Mesothelioma specialists involved included:
- Dr. Hedy Lee Kindler, the director of the mesothelioma program at the University of Chicago Cancer Center
- Dr. Raphael Bueno, the chief of thoracic surgery at Brigham and Women’s Health
- Dr. Valerie Rusch, a mesothelioma researcher at the Memorial Sloan Kettering Cancer Center
- Dr. Harvey Pass, the director of thoracic surgery at New York University Langone Medical Center
New Pathological Recommendations for Pleural Mesothelioma
There are three types of mesothelioma based on the disease’s location: pleural, peritoneal and pericardial. Pleural mesothelioma is the most common type.
There are also three types of mesothelioma cells: epithelial, sarcomatoid and biphasic. Whichever one a patient has can determine their prognosis and treatment plan.
The mesothelioma diagnostic process usually concludes with a biopsy, which involves extracting a tissue sample. The pathologist then studies the cells and can determine the cellular type of the mesothelioma. The group’s recommendations are specific to this process and how specialists should proceed with treatment.
The experts listed 13 recommendations for pathologists and specialists to follow when diagnosing mesothelioma patients and determining a treatment approach. Some of the most notable changes are:
- Chemotherapy should be available for all cellular subtypes of mesothelioma
- First-line clinical trials should consider patients with sarcomatoid or biphasic mesothelioma (with exceptions)
- A biopsy should include samples from three separate areas of the pleural cavity
- Multidisciplinary tumor boards should include pathologists to ensure consideration of appropriate treatment options
- Pathologists should consider the “architectural patterns” of mesothelioma cells, which means the arrangement of cells in the tumors
- Experts should investigate mesothelioma subtypes concerning patient response to immunotherapy
The groups concluded that these suggestions should lead to “more informative pathologic reporting” and “support clinical practice, research investigation and clinical trials.”
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- EURACAN/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(19)33232-0/pdf. Accessed: 10/15/19.