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T. Tsujimura
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P2.09 - Mesothelioma (ID 710)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.09-006 - FISH Analysis of p16 and BAP1 Immunohistochemistry for the Diagnosis of Mesothelioma (ID 9144)
09:30 - 09:30 | Author(s): T. Tsujimura
- Abstract
Background:
Distinction between mesothelioma and reactive mesothelial proliferation is difficult because of cytological and morphological overlap between these conditions. It is also difficult to differentiate sarcomatoid mesothelioma from fibrous pleuritis on biopsy. However, separation of reactive mesothelial proliferation from epithelioid mesothelioma and that of fibrous pleuritis from sarcomatoid mesothelioma is important because of therapeutic option and prognosis of the patients. There are some reports claiming that ancillary techniques such as fluorescence in situ hybridization (FISH) analysis of p16 and immunohistochemistry of BAP1 improve the diagnostic accuracy of mesothelioma. However, reported sensitivity of p16 FISH and BAP1 loss is different depending on the subtype of mesothelioma and on studies from various authors. The aim of this study was to elucidate the frequency of p16 deletion and BAP1 loss in mesotheliomas by multiple institutions in Japan.
Method:
We collected 262 malignant pleural mesotheliomas, 29 malignant peritoneal mesotheliomas, 23 cases with reactive mesothelial proliferation, and 37 cases with fibrous pleuritis from Tokyo Women’s Medical University, Chiba Rosai Hospital, Fukuoka University, Hyogo Medical University, Kagawa University, and Kanagawa Cancer Center. FISH analysis was performed with p16 probe. Immunostaining was performed with anti-BAP1 antibody.
Result:
We analyzed 262 pleural mesotheliomas (170 epithelioid, 38 biphasic, and 54 sarcomatoid) with p16 FISH, and 92 pleural mesotheliomas (58 epithelioid, 20 biphasic and 14 sarcomatoid) with BAP1 immunohistochemistry. Homozygous deletion (HD) of p16 was observed in 74% of epithelioid, 92% of biphasic, and 100% of sarcomatoid mesotheliomas. BAP1 loss was observed in 64% of epithelioid mesotheliomas and 55% of biphasic mesotheliomas, but not in sarcomatoid mesotheliomas. Concordance of HD of p16 and BAP1 loss between epithelioid and sarcomatoid components of 19 biphasic mesotheliomas was 100%. We analyzed 29 peritoneal mesotheliomas (25 epithelioid, 2 biphasic, and 2 sarcomatoid) with p16 FISH and 9 peritoneal epithelioid mesotheliomas with BAP1 loss. HD of p16 was observed in 52% of epithelioid mesotheliomas, 50% of biphasic mesotheliomas, and 50% of sarcomatoid mesotheliomas. BAP1 loss was observed in 56% of epithelioid mesotheliomas. No case with reactive mesothelial proliferation or fibrous pleuritis harbored HD of p16 and showed BAP1 loss.
Conclusion:
Separation of epithelioid or biphasic mesothelioma from reactive mesothelial proliferation may be possible with p16 FISH and/or BAP1 immunohistochemistry. Because all of the pleural sarcomatoid mesotheliomas but no cases with fibrous pleuritis harbor HD of p16, p16 FISH helps the separation of sarcomatoid mesothelioma from fibrous pleuritis, but BAP1 does not.
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P2.09-007 - Pleural Biopsy in Patients Suspected of Malignant Pleural Mesothelioma Consecutive 377 Cases (ID 9022)
09:30 - 09:30 | Author(s): T. Tsujimura
- Abstract
Background:
Video-assisted thoracic surgery (VATS) pleural biopsy is a most reliable diagnostic procedure for malignant pleural mesothelioma (MPM), however, its surgical outcomes are still unknown. The purpose of this study was to analyze the surgical outcome of VATS pleural biopsy in patients suspected of MPM.
Method:
A total of 377 patients received VATS pleural biopsy with suspected of MPM from March 2004 to December 2016 were included in the study. We evaluated their surgical outcome based on diagnostic accuracy, mortality, morbidity.
Result:
Of 377 patients, VATS pleural biopsy led to diagnosis as MPM in 250, carcinomatous pleurisy in 22 and chronic pleuritis in 105. However, of these 105 chronic pleuritis patients, 10 patients were received re-biopsy to establish the definitive diagnosis. Re-biopsy revealed 9 patients finally diagnosed as MPM, and 1 patient as carcinomatous pleurisy. The diagnostic accuracy of initial VATS pleural biopsy for MPM was 96.5% (250/259). The causes of miss-diagnosis were sampling error in all 9 cases, and the causes of sampling error as follows: no visible tumor in 4, complicated empyema in 2, severe adhesion in 2, and desmoplastic MPM in 1. The median postoperative stay was 5 days (1-114).Postoperative complication. Median age was 68 years (range, 40-85 years), with a 5- day (range 1-114 days) median length of stay. Postoperative complication occurred in 25 patients (5.7%), and 1 patient (0.26%) died due to postoperative empyema. Complications of this study included the following: injury of lung parenchyma in 7, wound infection in 4, re-expanding pulmonary edema in 3, empyema, gastrointestinal perforation and delirium in 2, fetal arrhythmia, cholecystitis hemothorax, liver dysfunction, acute respiratory failure in 1.
Conclusion:
VATS pleural biopsy could lead to definitive diagnosis in most case of MPM, but we should consider their limitation of diagnostic ability and the risk of VATS biopsy.
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P3.09 - Mesothelioma (ID 725)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.09-009 - Fourteen Cases Study of 5 Year Survivors of Malignant Pleural Mesothelioma Following Extrapleural Pneumonectomy (ID 9917)
09:30 - 09:30 | Author(s): T. Tsujimura
- Abstract
Background:
We performed extrapleural pneumonectomy (EPP) as curative intent surgery for malignant pleural mesothelioma (MPM) from 2004 to 2012. We investigated that factors associated with long term survival in our current cases.
Method:
We retrospectively reviewed some factors concerning the patients underwent EPP from April 2004 to march 2017 and past more than 5 years after operation. We analyzed age, sex, epidemiology, side, clinical stage, measurements of pleural thickness, the value of SUV max of PET-CT, pathological stage, length from EPP to recurrence and end results.
Result:
A total of 54 patients were enrolled to this study. Six patients who had exploratory thoracotomy and three patients who had not macroscopic complete resection were excluded. Overall, 14 patients (31%) survived at least 5 years (Group S), and 31 patients (68%) survived less than 5 years (Group N). All patients had EPP. In Group S, 10 males (71%) and 4 females (29%); age when they had operation ranged from 37 to 69 years with a median age of 57.5 years. All of them, histological subtypes were epithelial type. By the comparison between Group S and Group N, there were significant differences among the value of SUV max of PET-CT validation of pre and post neoadjvant chemotherapy(＜3.0 vs ≧3.0, p=0.03), length from EPP to radiotherapy (＜60 days vs ≧60 days, p=0.02), length from EPP to recurrence (＜1 year vs ≧1 year, p=0.0001).
Conclusion:
More than 30% patients survived at least 5 years in this study. One patient survived more than 10 years. Another patient survived more than 8 years without recurrence. This case suggest that cancer of the patient possibly cured radically. In the future, we need comparison the prognosis, complication, quality of life (QOL) between the patients who underwent EPP and the patients who underwent pleurectomy/decortications (P/D).
