Could there be a new way to assess a mesothelioma case – and therefore, a new way to determine mesothelioma stages?
The American Journal of Surgical Pathology published a consideration of a Mesothelioma Weighted Grading Scheme. This system considers patient age, cancer histology (cell type), number of cells undergoing mitosis (cell division), appearance of cell nuclei, necrosis (death of all or most cells in an organ or tissue area) and BAP1 expression. All of these can be used to stage mesothelioma.
Each category gets a score from 0-10, with low being less severe and high being more concerning. The hope is to learn new ways to determine the gravity of an individual case upon diagnosis and testing.
Doctors used this scheme for 369 cases of pleural mesothelioma. The median survival changed drastically based on the scores:
- 17 months for low grades
- 10 months for intermediate scores
- 4 months for high scores
Age is an obvious criteria. Older patients often have a shorter life expectancy. Same is true for histology, with sarcomatoid cells tougher to remove with surgery.
Cell division, the appearance of cell nuclei and necrosis are all ways to determine how fast cells are replicating (a sign of cancer), abnormalities in the nuclei appearance (sign of cancer) and how far the disease has spread.
According to the report in the journal, traditional grading systems often cannot assess survival for sarcomatoid histology. Epithelioid and biphasic histology cases are easier to diagnose and assess.
Another advantage of the Mesothelioma Weighted Grading Scheme is BAP1 expression. Traditional models often cannot differentiate life expectancy when the BAP1 protein is retained.
Sources & Author
- A Critical Assessment of Current Grading Schemes for Diffuse Pleural Mesothelioma With a Proposal for a Novel Mesothelioma Weighted Grading Scheme (MWGS). American Journal of Surgical Pathology. Retrieved from: https://journals.lww.com/ajsp/Abstract/9000/A_Critical_Assessment_of_Current_Grading_Schemes.97085.aspx. Accessed: 12/24/2021.
Sources & Author
