title: Pathology reporting of malignant pleural mesothelioma first diagnosis: A population-based approach.
abstract: Accurate pathologic diagnosis and reporting in malignant pleural mesothelioma are essential for clinical care, and cancer registration. Practical guidelines for pathologists are provided in publications and textbooks but it is unclear how these recommendations are applied in routine practice. We investigated the characteristics of pathology reports, and the extent to which they meet guideline standards. We reviewed 819 pathology reports relating to a first diagnosis of malignant pleural mesothelioma. Data sources were a regional section of the Italian network of the Mesothelioma Registry (2001-2014) and a pathology archive (1990-2000). We evaluated tumor characteristics, the diagnosis field including terminology and immunohistochemistry (IHC) workup, and report completeness (the proportion of items recorded). We investigated also two IHC panels identified by the most used markers in current practical guidelines, one best suited for epithelioid mesotheliomas (combinations of at least 2 positive and at least 2 negative mesothelioma markers) and the other best suited for sarcomatoid mesotheliomas (positive mesothelioma markers plus cytokeratins). Reports (753 histology, 66 cytology, IHC-confirmed 86%) were 74% complete and always narrative. Missing data were related to clinical history (76%), tumor laterality (61%), specimen size (38%), and histological subtype (23%). The proportion of cases with IHC was higher for epithelioid (90%) than sarcomatoid mesothelioma (87%). Compliance to IHC recommendations was higher for epithelioid (59%) than sarcomatoid mesothelioma (11%). The mean number of stains was significantly higher for sarcomatoid than epithelioid mesothelioma (p<0.000; Kruskal-Wallis test). Our findings show that although guidelines are designed to improve actual reporting practices, there is ample room for improvement in their application to standardize the diagnosis of mesothelioma. Synoptic pathology reporting needs to be implemented to better utilize pathology information.
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena, 324, 00161 Rome, Italy. Electronic address: valeria.ascoli@uniroma1.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Ascoli
authors.affiliation: Unit of Statistics, Italy's Institute of Public Health (Istituto Superiore di Sanità), Viale Regina Elena, 299, 00161 Rome, Italy. Electronic address: giada.minelli@iss.it.
authors.forename: Giada
authors.initials: G
authors.lastname: Minelli
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy. Electronic address: ilaria.cozzi.ic@gmail.com.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cozzi
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy. Electronic address: e.romeo@deplazio.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy. Electronic address: caterinacarnovalescalzo@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Carnovale Scalzo
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy. Electronic address: l.ancona@deplazio.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Ancona
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy. Electronic address: f.forastiere@deplazio.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D014408:Biomarkers, Tumor; D003937:Diagnosis, Differential; D019983:Guideline Adherence; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008499:Medical Records / Q000592:standards*; D008654:Mesothelioma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000086002:Mesothelioma, Malignant; D010336:Pathology / Q000592:standards*; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D017410:Practice Guidelines as Topic
chemical_list: D014408:Biomarkers, Tumor
keywords: Cancer registry; Diagnosis; Immunohistochemistry; Malignant pleural mesothelioma; Pathology reporting