title: Immunohistochemistry and molecular diagnostics of pleural malignant mesothelioma.
abstract: BACKGROUND
  The pathologic approach to pleural-based lesions is stepwise and uses morphologic assessment, correlated with clinical and imaging data supplemented by immunohistochemistry (IHC), and more recently, molecular tests, as an aid for 2 main diagnostic problems: malignant mesothelioma (MM) versus other malignant tumors and malignant versus reactive mesothelial proliferations.
  
  
  OBJECTIVE
  To present the current knowledge regarding IHC and molecular tests with respect to MM diagnosis, and in particular, the differentiation of the epithelioid type of MM from carcinoma metastatic to the pleural cavity.
  
  
  METHODS
  A review of immunohistochemical features of 286 consecutive MMs from 459 cases of pleural pathology, diagnosed during routine practice from 2003 to 2009. A survey of biomedical journal literature from MedLine/PubMed (US National Library of Medicine) focused on MM and associated tissue-based diagnostic IHC markers and molecular tests.
  
  
  CONCLUSIONS
  The search for a single diagnostic marker of MM has so far been discouraging, given the biologic and phenotypic tumor heterogeneity of MM. The use of antibody panels has gained unanimous acceptance especially in the differential diagnosis between MM and metastatic carcinoma, whereas the usefulness of IHC is more limited when dealing with spindle cell malignancies or distinguishing malignant from reactive mesothelium. A great degree of interlaboratory variability in antibody combinations and clone selection within diagnostic panels still exists. Current investigations aim at selecting the most suitable and cost-effective combination of antibodies by using novel statistical approaches for assessing diagnostic performance beyond the traditional measures of sensitivity and specificity.
authors.affiliation: Pathology Unit, Azienda Ospedaliera Nazionale, Alessandria, Italy. pgbetta@ospedale.al.it
authors.forename: Pier-Giacomo
authors.initials: PG
authors.lastname: Betta
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
authors.forename: Thea
authors.initials: T
authors.lastname: Bensi
authors.forename: Nicol Francesca
authors.initials: NF
authors.lastname: Trincheri
authors.forename: Sara
authors.initials: S
authors.lastname: Orecchia
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D002869:Chromosome Aberrations; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D017404:In Situ Hybridization, Fluorescence; D008654:Mesothelioma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D057089:Pathology, Molecular / Q000379:methods*; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor