title: Improving the Accuracy of Mesothelioma Diagnosis in China.
abstract: In the Western world, malignant mesothelioma (MM) is most prevalent in the pleura of older males who have been professionally exposed to asbestos. Information about MM from rapidly industrializing countries such as China is minimal. There is concern that a proportion of MM diagnoses in China may be incorrect because most Chinese physicians do not have experience diagnosing this rare cancer. We recently reported an unusually high incidence of peritoneal MM among eastern Chinese female patients. Here, we review the accuracy of MM diagnoses in China and provide suggestions to improve the accuracy of diagnosis.
  
  
  
  We reviewed 92 pathological diagnosis of MM in 2002-2015 from two reference centers in the province of Zhejiang in eastern China. We performed a large set of immunohistochemistry analyses to increase the reliability of the diagnosis.
  
  
  
  We confirmed the MM diagnosis in 12 of 34 of the pleural tumors (35.3%), in 38 of 56 of the peritoneal tumors (67.9%), and in two of two of the MMs of the tunica vaginalis (100%). MMs were characterized by tumor cells showing nuclear Wilms tumor 1 and calretinin staining and by strong membranous staining for cytokeratin CAM5.2. The results of staining for the epithelial markers carcinoembryonic antigen, thyroid transcription factor-1, MOC31, BerEP4, p63, p40, paired box 8, ER and PR were negative. BRCA1 associated protein 1 nuclear staining was lost in percentages similar to what has been reported for samples from Western countries.
  
  
  
  Our findings suggest that MM-especially in its pleural localization-is often misdiagnosed in eastern China. Identifying pitfalls and possible solutions in the pathological diagnosis of MM will affect both the standard of care and research in China.
authors.affiliation: Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Zhenying
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii. Electronic address: mcarbone@cc.hawaii.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Carbone
authors.affiliation: Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, People's Republic of China.
authors.forename: Xing
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, People's Republic of China.
authors.forename: Dan
authors.initials: D
authors.lastname: Su
authors.affiliation: Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Wenyong
authors.initials: W
authors.lastname: Sun
authors.affiliation: Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, People's Republic of China.
authors.forename: Jianlin
authors.initials: J
authors.lastname: Lou
authors.affiliation: Yuyao People's Hospital, Yuyao, Zhejiang, People's Republic of China.
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Yuyao Center of Disease Control and Prevention, Yuyao, Zhejiang, People's Republic of China.
authors.forename: Dichu
authors.initials: D
authors.lastname: Shao
authors.affiliation: Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, People's Republic of China.
authors.forename: Junqiang
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Gu
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Jinlin
authors.initials: J
authors.lastname: Hu
authors.affiliation: Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, People's Republic of China; Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Kaiyan
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.affiliation: Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: Herbert
authors.initials: H
authors.lastname: Yu
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: Andrea
authors.initials: A
authors.lastname: Napolitano
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: Haining
authors.initials: H
authors.lastname: Yang
authors.affiliation: Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, People's Republic of China; Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Mao
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000453:epidemiology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: BAP1; China; IHC; Mesothelioma