Comment on EURACAN/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach

摘要

The authors ought to be congratulated on standardizing pathological classification detailed analysis of currently available evidence of the pleural mesothelioma (1). They have reviewed the importance of adequate tissue sampling, and pathology reporting of features that include architecture, nuclear grading and histological characteristics that are important prognostic markers. These are important in the diagnosis and management considerations in mesothelioma. At present, it is not uncommon for patients to be referred to specialized centers where the pathology reporting of sampled tissue is suboptimal and the basic details are lacking which makes arriving at management decisions more challenging. This proposal hopefully will help and set some expectations of detailed pathological reporting to provide the clinicians with adequate information that are necessary for management decisions. This proposal further emphasizes why it is important that the patients with mesothelioma should be managed in specialized mesothelioma centers to allow proper diagnostic evaluation, pathologic classification and treatment decisions. The authors had attempted to identify histologic and molecular biomarkers that are prognostic in nature so that we identify patients with more aggressive disease. Establishing predictive pathologic information that inform treatment decisions is still a subject of research. There are ongoing efforts in searching for actionable biomarkers in mesothelioma but there has been no level 1 evidence or FDA approved therapies for this fatal disease yet (Table 1).