Accurate Mesothelioma Diagnosis Without Biopsy Now Possible

Mesothelioma doctors dream of being able to accurately diagnose you without conducting a biopsy.

Unfortunately, today’s gold standard for malignant pleural mesothelioma diagnosis is pleural biopsy followed by in-lab histologic analysis of the extracted tissue specimen.

Now, however, Pittsburgh researchers from Carnegie Mellon University and Allegheny General Hospital, believe they’ve hit on a mesothelioma diagnosis technique that doesn’t involve biopsy but is at least as accurate – maybe more so.

The technique involves using a conventional but much less invasive technique for acquiring suspect cells rather than entire tissues or masses.

To be more specific, it is the suspect cells’ nuclear structure and chromatin distribution that tells the tale, according to the Carnegie and Allegheny researchers.

Abnormality at the Core of Mesothelioma Cells

The suspect cells in this study were obtained using a technique known as effusion cytology. Effusion cytology concerns the collection of bodily fluids, especially those within the pleura, peritoneum and pericardium.

The examination of these collected fluids is known as cytopathology. Cytopathologists examine these fluids because they can contain disease cells that have been shed.

Cytopathologists are particularly interested in looking at the nuclei of cells they run across when they put a sample of the fluid under the microscope.

They are keen about the cell nucleus because in cancers — mesothelioma included — this particular structure will display certain abnormalities.

For example, the nucleus of a cancer cell is typically darker, larger and not as well organized as the nucleus of a healthy cell.

Also, the innermost core of a cancer cell’s nucleus tends to be bright red. By comparison, the innermost core — called the nucleolus — is a bluish hue in a normal, healthy cell.

The researchers figured out a way to take digitized images of the cells they examined and then process those through a computer to analyze whether the nuclei were healthy or cancerous.

The researchers tested this technique on 34 adults and arrived at the correct diagnosis every time, they wrote in the journal Cytometry Part A.

The researchers came away from their project feeling very confident, especially after performing comparison tests involving biopsied specimens and histology-oriented exams.

In their words, “[T] he new method can significantly outperform standard numerical feature-type methods in terms of agreement with the clinical diagnosis gold standard.”

That’s the polite way of saying malignant mesothelioma detection and diagnosis based on effusion cytology-acquired specimens and nuclear-structure analysis could emerge as the new gold standard of mesothelioma diagnosis.

Extracting Mesothelioma Cells from Pleural Fluid

With the current system of mesothelioma diagnosis, tissue and tumor specimens for histologic analysis are acquired by either a thoracoscopy or open thoracotomy.

However, these two procedures — being biopsies — require invasive surgery.

With the new method, cell specimens for cytologic analysis are acquired via thoracocentesis.

Thoracocentesis is a much less invasive procedure. It entails collecting fluid from the pleural space surrounding the lungs.

There are several ways by which this can be done. The one most likely to be used is the technique known as fine-needle aspiration.

Here, a needle — approximately 23- to 27-guage in thickness — is attached to a syringe and guided to the cancer cells by CT or ultrasound scanning. The needle is attached to a syringe-like device that suctions up the pleural fluid.

If you have mesothelioma, mesothelioma cells along with non-mesothelioma cells will be free-floating within that fluid.

The mesothelioma cells will stand out once a sample of the fluid is put under the microscope and run through the computer program.

However, this method of mesothelioma diagnosis won’t replace the current system overnight.

Effusion cytology-acquired specimens and nuclear-structure analysis still must be thoroughly tested and approved for clinical use.