Mesothelioma laboratory tests: Difference between revisions

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{{Mesothelioma}}
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==Overview==
==Overview==
Laboratory findings consistent with the diagnosis of mesothelioma include abnormal [[pleural fluid]] analysis (decreased pH and [[pleural fluid]]/[[serum glucose]] ratio). The presence of [[serum]] biomarkers such as soluble [[mesothelin]] (SM) and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma. Additional laboratory tests include immunophenotypic analysis to identify cell lines of mesothelioma.
==Laboratory Findings==
==Laboratory Findings==
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by [[chest X-ray]] and often [[spirometry|lung function tests]]. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A [[computed tomography|CT]] (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by [[cytology]] if this fluid is [[Needle aspiration biopsy|aspirated]] with a syringe. For pleural fluid this is done by a [[pleural tap]] or [[chest drain]], in ascites with an [[paracentesis]] or ascitic drain and in a pericardial effusion with [[pericardiocentesis]]. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. [[tuberculosis]], [[heart failure]]).
===Pleural Fluid Analysis===
 
*[[Pleural fluid]] analysis, via [[thoracentesis]], may be performed to help in the diagnosis of pleural mesothelioma.<ref name="pmid1914546">{{cite journal| author=Gottehrer A, Taryle DA, Reed CE, Sahn SA| title=Pleural fluid analysis in malignant mesothelioma. Prognostic implications. | journal=Chest | year= 1991 | volume= 100 | issue= 4 | pages= 1003-6 | pmid=1914546 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1914546  }} </ref>
If cytology is positive or a plaque is regarded as suspicious, a [[biopsy]] is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a [[histopathology|pathologist]]. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a [[thoracoscopy]]. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
*[[Pleural]] mesothelioma is associated with decreased [[pleural]] pH (< 7.30) and decreased [[pleural fluid]]/[[serum glucose]] ratios.
 
*[[Pleural fluid]] [[cytology]] may or may not be positive for mesothelioma.<ref name="pmid24920946">{{cite journal| author=Na MJ| title=Diagnostic tools of pleural effusion. | journal=Tuberc Respir Dis (Seoul) | year= 2014 | volume= 76 | issue= 5 | pages= 199-210 | pmid=24920946 | doi=10.4046/trd.2014.76.5.199 | pmc=PMC4050067 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24920946  }} </ref>
If the cancer is in the abdomen, the doctor may perform a [[laparoscopy]]. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
===Serum Biomarker===
 
The presence of [[serum]] biomarkers such as soluble [[Mesothelin|mesothelin (SM)]] and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma.<ref name="pmid10232421">{{cite journal |vauthors=Orengo AM, Spoletini L, Procopio A, Favoni RE, De Cupis A, Ardizzoni A, Castagneto B, Ribotta M, Betta PG, Ferrini S, Mutti L |title=Establishment of four new mesothelioma cell lines: characterization by ultrastructural and immunophenotypic analysis |journal=Eur. Respir. J. |volume=13 |issue=3 |pages=527–34 |date=March 1999 |pmid=10232421 |doi= |url=}}</ref>
{| border="1" cellpadding="5" cellspacing="0" align="center"
===Immunophenotypic analysis===
|+'''Typical [[immunohistochemistry]] results'''
*All cell lines of mesothelioma express surface [[human leukocyte antigen]] ([[Human leukocyte antigen|HLA]]) class I and [[intercellular adhesion molecule-1]] ([[ICAM-1]]).<ref name="pmid20075387">{{cite journal |vauthors=Hollevoet K, Nackaerts K, Thimpont J, Germonpré P, Bosquée L, De Vuyst P, Legrand C, Kellen E, Kishi Y, Delanghe JR, van Meerbeeck JP |title=Diagnostic performance of soluble mesothelin and megakaryocyte potentiating factor in mesothelioma |journal=Am. J. Respir. Crit. Care Med. |volume=181 |issue=6 |pages=620–5 |date=March 2010 |pmid=20075387 |doi=10.1164/rccm.200907-1020OC |url=}}</ref>
|-
*[[Chromosome 6 (human)|Chromosome-6]] abnormalities are commonly found in with mesothelioma cell lines with abnormal [[Karyotype|karyotypes]].
|style="width:300px"|'''Positive'''
*In addition these cell lines on immunophenotypic analysis may show:
|style="width:300px"|'''Negative'''
**[[Vimentin]]
|-
**[[Cytokeratin]] 8
|EMA (epithelial membrane antigen) in a membranous distribution
**[[Cytokeratin]] 18
|CEA ([[carcinoembryonic antigen]])
**Mesothelial antigen recognized by HBME-1 [[Monoclonal antibodies|monoclonal antibody]]
|-
===Fluorescence In Situ Hybridization (FISH)===
|WT1 (Wilms' tumour 1)
*[[FISH]] may be helpful in the [[diagnosis]] of [[mesothelioma]]. It helps in distinguishing [[malignant]] [[mesothelioma]] from reactive [[mesothelial]] [[cells]] in effusions.<ref name="pmid20139227">{{cite journal| author=Savic S, Franco N, Grilli B, Barascud Ade V, Herzog M, Bode B et al.| title=Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology. | journal=Chest | year= 2010 | volume= 138 | issue= 1 | pages= 137-44 | pmid=20139227 | doi=10.1378/chest.09-1951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20139227  }} </ref>
|B72.3
*Mutlitarget [[Fluorescence in situ hybridization|FISH]] [[Assays|assay]] may be used to detect [[chromosomal]] abberations ([[chromosome 3|chromosomes 3]], [[chromosome 7|7]], [[chromosome 17|17]], and [[chromosome 9|9p21]]).
|-
*[[Fluorescence in situ hybridization|FISH]] technique may also be used to explore the alternative [[Mechanism (biology)|mechanism]] of [[tumor suppressor gene]] inactivation by [[methylation]] of ''[[p16]]'', ''p14'', and ''p15'' [[gene]] in the [[pathogenesis]] of mesothelioma.<ref name="pmid20139227">{{cite journal| author=Savic S, Franco N, Grilli B, Barascud Ade V, Herzog M, Bode B et al.| title=Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology. | journal=Chest | year= 2010 | volume= 138 | issue= 1 | pages= 137-44 | pmid=20139227 | doi=10.1378/chest.09-1951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20139227  }} </ref>
|Calretinin
|MOC-3 1
|-
|Mesothelin-1
|CD15
|-
|Cytokeratin 5/6
|Ber-EP4
|-
|HBME-1 (human mesothelial cell 1)
|TTF-1 ([[thyroid transcription factor-1]])
|}


==References==
==References==
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[[Category:Asbestos]]
[[Category:Asbestos]]
[[Category:Occupational diseases]]
[[Category:Occupational diseases]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 16:39, 11 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Laboratory findings consistent with the diagnosis of mesothelioma include abnormal pleural fluid analysis (decreased pH and pleural fluid/serum glucose ratio). The presence of serum biomarkers such as soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma. Additional laboratory tests include immunophenotypic analysis to identify cell lines of mesothelioma.

Laboratory Findings

Pleural Fluid Analysis

Serum Biomarker

The presence of serum biomarkers such as soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma.[3]

Immunophenotypic analysis

Fluorescence In Situ Hybridization (FISH)

References

  1. ↑ Gottehrer A, Taryle DA, Reed CE, Sahn SA (1991). "Pleural fluid analysis in malignant mesothelioma. Prognostic implications". Chest. 100 (4): 1003–6. PMID 1914546.
  2. ↑ Na MJ (2014). "Diagnostic tools of pleural effusion". Tuberc Respir Dis (Seoul). 76 (5): 199–210. doi:10.4046/trd.2014.76.5.199. PMC 4050067. PMID 24920946.
  3. ↑ Orengo AM, Spoletini L, Procopio A, Favoni RE, De Cupis A, Ardizzoni A, Castagneto B, Ribotta M, Betta PG, Ferrini S, Mutti L (March 1999). "Establishment of four new mesothelioma cell lines: characterization by ultrastructural and immunophenotypic analysis". Eur. Respir. J. 13 (3): 527–34. PMID 10232421.
  4. ↑ Hollevoet K, Nackaerts K, Thimpont J, Germonpré P, Bosquée L, De Vuyst P, Legrand C, Kellen E, Kishi Y, Delanghe JR, van Meerbeeck JP (March 2010). "Diagnostic performance of soluble mesothelin and megakaryocyte potentiating factor in mesothelioma". Am. J. Respir. Crit. Care Med. 181 (6): 620–5. doi:10.1164/rccm.200907-1020OC. PMID 20075387.
  5. ↑ 5.0 5.1 Savic S, Franco N, Grilli B, Barascud Ade V, Herzog M, Bode B; et al. (2010). "Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology". Chest. 138 (1): 137–44. doi:10.1378/chest.09-1951. PMID 20139227.


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