Mesothelioma cytology can be helpful in making a diagnosis of this rare and deadly cancer. Under the microscope, doctors can examine fluid samples to look for mutated cells.
What Exactly Is Mesothelioma Cytology?
Mesothelioma cytology, also known as mesothelioma cytopathology, is the examination of cells to determine the presence of mesothelioma. It is a branch of pathology that studies tissue or fluid in mesothelioma.
The study of cell structure and function is referred to as “cytology.” The examination of cells for disease is known as cytopathology. Cytopathology and cytology are terms that are used interchangeably.
The following are the most notable features of mesothelioma cytology:
- Less invasive than tissue biopsy (mesothelioma histology), this procedure frequently necessitates a small needle incision.
- There will be no scarring on the patient’s incision site.
- Anesthesia is usually not required for the patient.
- Samples are easier to obtain.
- A tissue biopsy is more expensive.
- Not as dependable as examining tissue samples
- Fluid samples have fewer cells to analyze than tissue samples.
How Does Mesothelioma Cytology Work?
Mesothelioma cytology begins with removing fluid from the patient’s body. Doctors collect fluid samples from patients suffering from mesothelioma symptoms.
If doctors detect signs of mesothelioma on imaging tests, they may order a biopsy. Some biopsies involve the removal of tissue, while others involve the removal of fluid samples.
How Are Fluid Samples Taken?
Non-surgical needle biopsies, often with fine-needle aspirations, are used to collect fluid samples. To remove fluid from a suspected tumor area, doctors use a syringe with a thin needle.
There are several methods for removing fluid for mesothelioma cytology. They differ depending on where your cancer started.
The following non-surgical biopsies are used to collect fluid samples:
Thoracentesis
Is procedure that removes fluid from the pleura or lung cavity in order to diagnose pleural mesothelioma.
Paracentesis
This is a procedure that removes fluid from the peritoneum or abdominal cavity in order to diagnose peritoneal mesothelioma.
Pericardiocentesis
A procedure that removes fluid from the pericardium (the sac that surrounds your heart) in order to diagnose pericardial mesothelioma.
Fluid buildup in the space where this cancer forms is common in patients. This is caused by one of three symptoms:
These are the symptoms:
Pleural effusions
Pleural effusions are fluid accumulations in the pleura, which is located between the lung cavity and the chest wall.
Ascites
Ascites is fluid in the peritoneum, which is the membrane that surrounds your abdomen.
Pericardial
Pericardial effusions are fluid accumulations in the pericardium.
After removing the fluid, doctors send it to a pathologist for mesothelioma cytology. A cytology report, also known as a pathology report, details the findings and may provide a mesothelioma diagnosis.
What Methods Do Doctors Use to Test Fluid Samples?
The procedure for testing fluid samples varies according to the number of cells and amount of blood collected. Samples with a lower cell count will necessitate the use of a high-powered microscope by a doctor. Blood-stained samples may require solutions (such as saline, a sodium chloride and water mixture) to dilute the blood.
Fluid samples are placed on slides and then dipped into a mixture of stains or chemical dyes. These stains indicate the presence of cancer.
Fluid Microscopic Sample
The three most frequently used stains for mesothelioma cytology are:
- Diff-Quik
- Papanicolaou
- May-Grünwald-Giemsa
Each stain binds to specific antibodies in the cancer cell, causing a reaction that changes the color of the cell. Pathologists can determine whether the fluid sample contains malignant mesothelioma cells by examining it under a microscope.
Pathologists identify mesothelioma cell types by examining cell size and shape. Pathologists use this method to determine whether a mesothelioma is primarily composed of epithelioid or sarcomatoid cells. Each cell type is associated with specific antibodies that are visible when stained.
According to research, cytology is the most effective method of diagnosing epithelioid mesothelioma. This cell type accounts for 50% to 70% of all mesothelioma cases. Epithelioid cells are easily distinguished.
Mesothelioma Cytology’s Limitations
Mesothelioma cytology reports are not always accurate in diagnosing the disease. There are three major reasons for process limitations:
- A Sample With Insufficient Cells — Not all fluid samples contain a sufficient number of cells to examine. This makes determining whether the disease is mesothelioma or one with similar characteristics difficult.
- Examining Cells In Fluid Is Difficult— Dr. Elliot Wakeam, a thoracic oncologist at Michigan Medicine, specializes in mesothelioma diagnosis. He stated that cytologists frequently struggle to analyze “the architecture of individual cells suspended in fluid.”
- Unreliable For Identifying All Cell Types — While mesothelioma cytology can identify epithelioid mesothelioma cells, it cannot be used to diagnose sarcomatoid mesothelioma.
According to a study published in the British Journal of Cancer, fluid samples are unreliable for diagnosing biphasic mesothelioma.
How to Obtain a Correct Mesothelioma Diagnosis
If your cytology report is inconclusive, your doctor will most likely order a mesothelioma pathology report via tissue biopsy.
This is referred to as a mesothelioma histology report.
According to one study published in UpToDate, camera-assisted tissue biopsies had a 98% accuracy in diagnosing mesothelioma. Fluid biopsies were only accurate in 26% of the cases in which they were used.
Following a mesothelioma cytology report, mesothelioma pathologists almost always request a tissue biopsy.
Most pathologists are hesitant to make a firm diagnosis based solely on fluid samples.
Furthermore, a histology report may provide more reliable information about the cell type than a cytology report.
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