Saturday, November 18, 2017

Duplicity among the dark triad: Three faces of deceit

 2017 Aug;113(2):329-342. doi: 10.1037/pspp0000139. Epub 2017 Mar 2.

Duplicity among the dark triad: Three faces of deceit.

Author information

1
Department of Psychology, University of Texas at El Paso.
2
Department of Psychology, University of British Columbia.

Abstract

Although all 3 of the Dark Triad members are predisposed to engage in exploitative interpersonal behavior, their motivations and tactics vary. Here we explore their distinctive dynamics with 5 behavioral studies of dishonesty (total N = 1,750). All 3 traits predicted cheating on a coin-flipping task when there was little risk of being caught (Study 1). Only psychopathy predicted cheating when punishment was a serious risk (Study 2). Machiavellian individuals also cheated under high risk-but only if they were ego-depleted (Study 3). Both psychopathy and Machiavellianism predicted cheating when it required an intentional lie (Study 4). Finally, those high in narcissism showed the highest levels of self-deceptive bias (Study 5). In sum, duplicitous behavior is far from uniform across the Dark Triad members. The frequency and nature of their dishonesty is moderated by 3 contextual factors: level of risk, ego depletion, and target of deception. This evidence for distinctive forms of duplicity helps clarify differences among the Dark Triad members as well as illuminating different shades of dishonesty. 

"Total episode expenditures for cancer resections were lower when care was delivered at low-complication, high-quality hospitals."

 2017 Nov 17. doi: 10.1002/cncr.31120. [Epub ahead of print]

Hospital quality, patient risk, and Medicare expenditures for cancer surgery.

Author information

1
National Clinician Scholars Program at the Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.
2
Department of Surgery, University of Michigan, Ann Arbor, Michigan.

Abstract

BACKGROUND:

Surgical resection is a cornerstone of curative-intent therapy for patients with solid organ malignancies. With increasing attention paid to the costs of surgical care, there is a new focus on variations in the costs of cancer surgery. This study evaluated the potential interactive effect of hospital quality and patient risk on expenditures for cancer resections.

METHODS:

With 100% Medicare claim data for 2010-2013, patients aged 65 to 99 years who had undergone cancer resection were identified. Medicare payments were calculated for the surgical episode from the index admission through 30 days after discharge. Risk- and reliability-adjusted hospital rates of serious complications and mortality within 30 days of the index operation were assessed to categorize high- and low-quality hospitals.

RESULTS:

There was no difference in patient characteristics between the highest and lowest quality hospitals. There were substantial increases in expenditures for procedures performed at the lowest quality hospitals for each procedure. Increased expenditures at the lowest quality hospitals were found for all patients, but they were highest for the highest risk patients. At low-quality hospitals, low-risk patients undergoing pancreatectomy had payments of $29,080, whereas high-risk patients had average payments of $62,687; this was a difference of $33,607 per patient episode.

CONCLUSIONS:

Total episode expenditures for cancer resections were lower when care was delivered at low-complication, high-quality hospitals. Expenditure differences were particularly large for high-risk patients, and this suggests that the selective referral of high-risk patients to high-quality centers may be an effective strategy for optimizing value in cancer surgery. 

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

 2017 Nov 15. doi: 10.1111/1556-4029.13690. [Epub ahead of print]

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity.

Author information

1
Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue SouthRoom 220, Birmingham, AL, 35233.

Abstract

Obesity can involve any organ system and compromise the overall health of an individual, including premature death. Despite the increased risk of death associated with being obese, obesity itself is infrequently indicated on the death certificate. We performed an audit of our records to identify how often "obesity" was listed on the death certificate to determine how our practices affected national mortality data collection regarding obesity-related mortality. During the span of nearly 25 years, 0.2% of deaths were attributed to or contributed by obesity. Over the course of 5 years, 96% of selected natural deaths were likely underreported as being associated with obesity. We present an algorithm for certifiers to use to determine whether obesity should be listed on the death certificate and guidelines for certifying cases in which this is appropriate. Use of this algorithm will improve vital statistics concerning the role of obesity in causing or contributing to death.

"When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list?"

 2017 Nov 15;42(6):670-689. doi: 10.1093/jmp/jhx021.

The Ethics of Organ Tourism: Role Morality and Organ Transplantation.

Author information

1
University at Albany, State University of New York, Albany, New York, USA.

Abstract

Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician." This role results from transplant physicians' participation in a system that depends on organ donors' voluntary act of donation.

"Public health experts say that telling people how to eat healthier isn’t changing behavior."

Now I Get It: America’s growing obesity problem


"Public health experts say that telling people how to eat healthier isn’t changing behavior. They’re urging lawmakers to create new policies that will change the food environment, making it easier for people to make healthy choices."

"If the Midwest is a particular place that instead thinks of itself as an anyplace or no-place, it is likewise both present and not present in the national conversation."

On Being Midwestern: The Burden of Normality

Phil Christman

When, looking in your own mind for a sense of your own experiences in a region, you find only clichés and evasions—well, that is a clue worth following. So I began, here and there, collecting tidbits, hoarding anecdotes, savoring every chance piece of evidence that the Midwest was a distinctive region with its own history. In doing so I noticed yet another paradox: If the Midwest is a particular place that instead thinks of itself as an anyplace or no-place, it is likewise both present and not present in the national conversation. The Midwest is, in fact, fairly frequently written about, but almost always in a way that weirdly disclaims the possibility that it has ever been written or thought about before. The trope of featurelessness is matched by a trope of neglect (for what can one do with what is featureless but neglect it?). Katy Rossing, a poet and essayist, has described the formula: 
1. Begin with a loquacious description of the Euclidean-flat homogeneity of the landscape. This place looks boring. It looks like there’s nothing here worth thinking about. Example: “The sins of the Midwest: flatness, emptiness, a necessary acceptance of the familiar. Where is the romance in being buried alive? In growing old?” (Stewart O’Nan, Songs for the Missing)
2. In fact, it seems no one has really thought about it before, they all write. What IS the Midwest? The West, South, and East all have clear stories, stories that are told and retold in regionally interested textbooks, novels, movies. The Midwest? It’s a humorously ingenuous, blank foil for another region. Example: Fargo, Annie Hall.
3. But wait a minute, the writers tell you, it turns out this place isn’t empty at all! They spend the remainder of the article crouched in a defensive posture.10

What makes a researcher wise?

 2017 Nov;12(6):1148-1152. doi: 10.1177/1745691617727528.

… and the Wisdom to Know the Difference: Scholarly Success From a Wisdom Perspective.

Author information

1
Department of Developmental Psychology, University of Klagenfurt.

Abstract

What makes a researcher wise? At least for the field of psychology, I argue that the two main characteristics of scholarly wisdom are a desire to understand, rather than to be right, and an orientation toward ethical values. These characteristics do not necessarily produce the highest levels of academic success. Because wisdom is partly context dependent, the actual wisdom of our scientific output could be increased by making some changes to our publication and evaluation culture-changes that might benefit our field and even the world around us.

'Fountain Of Youth': Amish Genetic Mutation Protects Against Aging


'Fountain Of Youth': Amish Genetic Mutation Protects Against Aging

Normally, the gene SERPINE1 makes PAI-1, a protein that is associated with aging. However, 43 of the 177 individuals tested were found to carry mutations on the gene. They were also found to have longer telomeres, or the protective caps at the end of our chromosomes, which is a biological marker of aging in which shorter telomeres are signs of aging.

Friday, November 17, 2017

Despite ACA cost protections, most adolescents skip regular checkups

Despite ACA cost protections, most adolescents skip regular checkups


"Before the health law passed in 2010, caregivers reported that 41 percent of children had a well-child visit in the previous year. After the ACA's preventive services protections became effective, typically in 2011, the rate climbed to 48 percent, a "moderate" increase, Adams said. The increase was greatest for minority and low-income groups.
Still, more than half of children in the survey didn't go to the doctor for routine care over the course of a year, even though many families gained insurance and wouldn't have owed anything for the visits."


Caring for the Tribe: From Addiction to Zen

 2017 Nov;15(6):578-580. doi: 10.1370/afm.2151.

Caring for the Tribe: From Addiction to Zen.

Author information

1
Seaport Community Health Center, Belfast, Maine david.loxterkamp@gmail.com.

Abstract

The culture of medicine is rapidly changing. The majority of primary care physicians are now employed, and the decisions that govern us are made farther and farther from the point of care. Our sense of well-being is threatened less by the demands of clinical practice than it is by the emptiness of our job: we have forgotten who we are working for, or working with, or why we are working at all. The solution lies in creating the kind of practice environment that we advocate for in each of our patients' lives.

"Incapacitated patients are assumed to have wishes, but to lack agency."

 2017 Nov 13. doi: 10.1093/medlaw/fwx051. [Epub ahead of print]

'…What God and the Angels Know of US?' Character, Autonomy, and Best Interests in Minimally Conscious State.

Author information

1
Centre for Ethics in Medicine, Bristol Medical School, Population Health Sciences, University of Bristol, UK.

Abstract

Determining the best interests of incapacitated patients has been observed to be an opaque area of the law, and this is no less so in decisions about the (non-)treatment of patients in the minimally conscious state. A systematic examination of the way best interests are used in judgments relating to this population suggests that narratives involving the character of the patient frequently form an important plank of judicial reasoning. Since insights into the concept of best interests may be gained by an engagement with the philosophy of well-being, I identify the court's character-based approach with perfectionist theories of well-being. These use human nature to furnish an objective list of abilities needed for human flourishing. Guided by the Mental Capacity Act (MCA), this list becomes focused primarily on autonomy. Incapacitated patients are assumed to have wishes, but to lack agency. Judges search for these wishes in narratives about the patient and supply the means to exercise these wishes. This analysis suggests three concerns about the court's approach: first, by placing so great a weight on autonomy, the law offers an impoverished account of human nature; secondly, adversarial law encourages partial determinations of character, and this raises concerns about whether the courts are equipped to explore the complexities of character narratives; and, thirdly, experimental psychology indicates character is not as predictable as an assessment under MCA requires. While character narratives may unburden decision-makers, this analysis suggests the limits of autonomy may have been exceeded in this area of the law.

Is altering a diagnosis to ensure medication coverage ethical?

 2016 Apr 14;2(2):67-68. doi: 10.1016/j.ijwd.2016.02.002. eCollection 2016 Jun.

The good, the bad, and the ugly of medication coverage: Is altering a diagnosis to ensure medication coverage ethical?

Author information

1
Dermatology and Surgery Department, University of Connecticut, Farmington, CT.

Abstract

Recently, a patient presented to the dermatology clinic suffering from disabling, recurrent palmoplantar vesicles and pustules. Biopsy demonstrated nondiagnostic histologic findings without unequivocal evidence for psoriasis. The localized rash was recalcitrant to a host of standard therapies. An anti-tumor necrosis factor biologic was considered, and experience suggested that this expensive medication would only be approved for coverage if a diagnosis was submitted for a Food and Drug Administration-approved indication as psoriasis. All health-care providers face similar dilemmas in caring for their own patients. To whom is the physician's primary responsibility when what is best for the patient may not align with the realities of our health-care system? Should a physician alter or exaggerate a medical diagnosis to obtain insurance coverage for a needed medication? What are the ethical implications of this action? If the physician's fiduciary duty to the patient had no limits, there would be multiple potential consequences including compromise of the health-care provider's integrity and relationships with patients, other providers, and third-party payers as well as the risk to an individual patient's health and creation of injustices within the health-care system.

"The Maya did not disappear, though cities were abandoned..."

Do civilisations collapse?

The idea that the Maya or Easter Islanders experienced an apocalyptic end makes for good television but bad archaeology


"The Maya did not disappear, though cities were abandoned and, over time, the population fell and aspects of Classic Maya life changed – the rule of the mighty holy lords, the k’uhul ajaw, was rejected. They were still there, living in a complex society, when the Spanish arrived in the 16th century. Cities and trade remained, and the Maya collected their wisdom in books. During and after the period of the collapses, new cities were founded (or refounded) – Chichen Itza, Mayapan, and Uxmal in the dry northern Yucatán, and rivalries between noble families continued. Periodically, cities would be abandoned by elite groups or sometimes by the whole population. This happened for several reasons – infighting and political intrigue, famine and plague. At Mayapan, we know from historical records, the noble Xiu clan massacred their Cocom rivals, usually cited as the reason for its abandonment in 1441-1461 CE, but the city might have suffered endemic violence for two centuries before this. Perhaps Cancuén and other Classic Maya cities had similar problems that led eventually to their collapse and abandonment."

"Mississippi tops the list as the fattest state in the United States."

Five southern States top Fattest States list

"Mississippi we’re looking at you. 

According to personal finance Web site WalletHub’s new report, 2017’s Fattest States in America, Mississippi tops the list as the fattest state in the United States. It’s followed closely by West Virginia, Tennessee, Arkansas and Louisiana. 

The bottom five states? Montana, Hawaii, Utah, Massachusetts and Colorado." 

Thursday, November 16, 2017

"Just 9 percent of adults eat enough vegetables and only 12 percent get the recommended amount of fruit daily..."



CDC wants America to eat its fruits and veggies


"Just 9 percent of adults eat enough vegetables and only 12 percent get the recommended amount of fruit daily, according to a new report from the U.S. Centers for Disease Control and Prevention."


Extracellular Vesicles: New Players in Lung Immunity

 2017 Nov 8. doi: 10.1165/rcmb.2017-0293TR. [Epub ahead of print]

Extracellular Vesicles: New Players in Lung Immunity.

Author information

1
Jikei University School of Medicine, Division of Respiratory Diseases, Department of Internal Medicine , Tokyo, Japan ; yuugot@gmail.com.
2
Jikei University School of Medicine, Division of Respiratory Diseases, Department of Internal Medicine, Tokyo, Japan ; tkskdt@gmail.com.
3
Jikei University School of Medicine, Division of Respiratory Diseases, Department of Internal Medicine,, Minato-ku, Tokyo, Japan ; md986001@yahoo.co.jp.
4
National Cancer Center Research Institute, Division of Molecular and Cellular Medicine, Tokyo, Japan ; tochiya@ncc.go.jp.
5
Jikei Medical University, Dpt of Respiratory Medicine, Tokyo, Japan ; kkuwano@jikei.ac.jp.

Abstract

Extracellular vesicles (EVs), such as exosomes and microvesicles, play an important autocrine/paracrine role in intercellular communication. Details on the involvement of EVs in the pathogenesis of lung diseases have emerged over the past several years. Moreover, EVs package numerous DNA, proteins, mRNAs, and microRNAs (miRNAs) that can regulate immune responses in recipient cells. Almost all respiratory cells release EVs, and these EVs can have protective or detrimental functions depending on the type of donor cells, type of stimuli, and components. In lung cancer, tumor-derived EVs carry multiple immunoinhibitory signals, disable anti-tumor immune effector cells and promote tumor escape from immune control. Furthermore, bacteria- and microbiota-derived EVs can shape the immune system and lead to the development of lung disease. These EVs are capable of maintaining airway homeostasis, inducing pro-inflammatory effects, and promoting antigen presentation, thus regulating lung inflammation and immune responses. From these viewpoints, we will summarize recent findings on EVs in lung biology and immunity. EVs provide a new avenue for understanding the mechanism of inflammatory disease progression and for developing therapeutic approaches for lung immune responses.

Simple arithmetic: Not so simple for highly math anxious individuals

 2017 Nov 11. doi: 10.1093/scan/nsx121. [Epub ahead of print]

Simple arithmetic: Not so simple for highly math anxious individuals.

Author information

1
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
2
Department of Psychology, The University of Chicago, Chicago, IL 60637, USA.
3
Department of Psychology, University of Ottawa, Ottawa, ON, Canada.
4
Barnard College, New York, NY 10027, USA.

Abstract

Fluency with simple arithmetic, typically achieved in early elementary school, is thought to be one of the building blocks of mathematical competence. Behavioral studies with adults indicate that math anxiety (feelings of tension or apprehension about math) is associated with poor performance on cognitively demanding math problems. However, it remains unclear whether there are fundamental differences in how high and low math anxious individuals approach overlearned simple arithmetic problems that are less reliant on cognitive control. The current study used functional magnetic resonance imaging to examine the neural correlates of simple arithmetic performance across high and low math anxious individuals. We implemented a partial least squares analysis, a data-driven, multivariate analysis method to measure distributed patterns of whole-brain activity associated with performance. Despite overall high simple arithmetic performance across high and low math anxious individuals, performance was differentially dependent on the fronto-parietal attentional network as a function of math anxiety. Specifically, low - compared to high - math anxious individuals perform better when they activate this network less - a potential indication of more automatic problem-solving. These findings suggest that low and high math anxious individuals approach even the most fundamental math problems differently.

Will “virtual medicine” transform the American health-care system?

The Hype of Virtual Medicine


Will “virtual medicine” transform the American health-care system? Will the latest computer-based technologies—apps, wearables, remote monitors and other high-tech devices—make Americans healthier?

Digital Health Not Just for Millennials



Digital Health Not Just for Millennials

"This is an important study as it shows that digital health is not just for millennials and shows how technology is being embraced by the Baby Boomer generation too. Online therapy offers an opportunity to reach older people who are less likely to respond to conventional mental health services as a result of stigma and mobility problems. Seniors are much more vulnerable to mental health problems compared to younger adults," commented Sarah Bateup.

"We call it fault-free obesity..."

Can't seem to lose weight? You may have this special gene


"We call it fault-free obesity," senior author Vann Bennett said in a statement. "We believe this gene might have helped our ancestors store energy in times of famine. In current times, where food is plentiful, ankyrin-B variants could be fueling the obesity epidemic."

Violence, insecurity, and the risk of polio: A systematic analysis

 2017 Oct 11;12(10):e0185577. doi: 10.1371/journal.pone.0185577. eCollection 2017.

Violence, insecurity, and the risk of polio: A systematic analysis.

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
2
The Bill and Melinda Gates Foundation, Seattle, Washington, United States of America.

Abstract

BACKGROUND:

Since the introduction of polio vaccines in the 1950's and 60's, eradication of poliovirus from the world has been technically feasible. Progress towards this goal, however, has been uneven and influenced by social and political factors that challenge the implementation of robust immunization programs. While violence and insecurity are often cited as barriers to eradication, current global risk models are largely based on virologic and immunologic indicators measured at national levels. In this manuscript, we quantify the relevance of indicators of violence and insecurity on the risk of polio spread.

METHODS AND FINDINGS:

Using logistic regression models and public data sources, we evaluate the relationship between measures of violence and instability and the location of poliomyelitis cases between 2006 and 2015 at the country-level, both individually and after controlling for more proximal determinants of disease, such as nearby circulating poliovirus and vaccination rates. We found that increases in a country's Fragile States Index (FSI) and Global Peace Index (GPI), aggregate indicators of violence and instability, were associated with the occurrence of poliovirus cases in the subsequent year (p< 0.01), even after controlling for established risk factors. These effects of violence and insecurity must be mediated through immunity and exposure to poliovirus, coarse measures of which are included in our model. This also implies that in our study, and in risk models in general, the interpretation depends on the quality and granularity of available data.

CONCLUSION:

National virologic and immunologic indicators understate the risk of poliovirus spread in areas with violence and insecurity, and the inclusion of such factors improves precision. In addition, the link between violence and incidence of disease highlights the broader challenge of implementing health interventions in conflict areas. We discuss practical implications of this work in understanding and measuring the risks to polio eradication and other global health initiatives, and the policy implications of the need to reach vulnerable populations in conflict zones.

Getting to the core of medicine: Developing undergraduate forensic medicine and pathology teaching

 2017 Oct 16;52:245-251. doi: 10.1016/j.jflm.2017.10.006. [Epub ahead of print]

Getting to the core of medicine: Developing undergraduate forensic medicine and pathology teaching.

Author information

1
Clinical Senior Lecturer in Forensic Pathology, Wales Institute of Forensic Medicine, Cardiff University School of Medicine, Cardiff, Wales, CF14 4XN, UK. Electronic address: jonesrm11@cardiff.ac.uk.

Abstract

Teaching and learning of forensic medicine and pathology in the undergraduate medical curriculum has been in decline for decades in the UK, and yet graduates are expected to be able to recognise, and protect, those who are most vulnerable in society - i.e. at risk of abuse or neglect - a matter highly relevant to the role of the forensic medical practitioner. When Cardiff University School of Medicine created a new 'learner-centred' undergraduate curriculum, championing case-based discussion in small groups, and earlier clinical contact, residual teaching on 'the pathology of trauma' disappeared. An opportunity to create a new course for the year 3 core curriculum, however, led to re-emergence of forensic medicine and pathology, with a focus on identification, and protection, of the 'vulnerable patient'. This paper describes the development process of the first two iterations of that course, and the influence of 'listening to the student voice'. Forensic medicine and pathology remain relevant in undergraduate medical education; effective, and ethical, safeguarding of the vulnerable is an essential 'core' skill of the modern medical graduate, and forensic medical practitioners can play an integral role in the preparation of medical students for their future clinical practice.

"Students who can’t keep up are diagnosed, drugged, and punished."

Not Every Kid-Bond Matures

Millennial habits so often mocked and belittled in the press are the survival strategies of a demographic “born into captivity.”

But not every kid-bond matures. Students who can’t keep up are diagnosed, drugged, and punished. The extraordinary proliferation of mood and attention disorders among the young, and their development into a lucrative pharmaceutical market, is only the logical complement of the human capital accumulation regime of testing, supervising, and debt-collecting. Depression, Harris notes, is up 1,000 percent over the last century, “with around half of that growth occurring since the late 1980s.” While there’s always a question about changing diagnoses with this sort of figure, Harris is convincing that there’s more to this phenomenon than an artifact of measurement. So too the growing punitive apparatus waiting to catch kids who fall off the track: “We can draw a straight line between the standardization of children in educational reform and the expulsion, arrest, and even murder of the kids who won’t adapt.” On this account, mass incarceration, too, is a generational phenomenon, and it makes its first appearances inside schools, which are now heavily policed zones, as are the public spaces in which working-class kids congregate. “Millennials are cagey and anxious, as befits the most policed modern generation,” Harris writes. In this way, the book effectively argues that widely different experiences of neoliberalism—from the grasping student’s anxiety for good grades to the policed young person of color dodging the cops—are nonetheless part of the same social process.

Stressed women more likely to develop obesity

Stressed women more likely to develop obesity


“This is important work because women are living longer and are more at risk for chronic illnesses, such as cardiovascular disease,” Albert said. “The potential public health impact is large, as obesity is related to increased risks of heart attack, stroke, diabetes and cancer, and contributes to spiraling healthcare costs.”
Albert and co-authors found that women who reported more than one traumatic life event compared with none at all saw an 11 percent increased risk of developing obesity. The same was true for negative life events, with women who said they’d experienced four or more negative events over the past five years seeing a 36 percent increased risk of obesity.

Wednesday, November 15, 2017

Current and emerging global themes in the bioethics of regenerative medicine: the tangled web of stem cell translation

 2017 Oct;12(7):839-851. doi: 10.2217/rme-2017-0065. Epub 2017 Nov 9.

Current and emerging global themes in the bioethics of regenerative medicine: the tangled web of stem cell translation.

Author information

1
Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.

Abstract

Probably the most serious problem facing the field of regenerative medicine today is the challenge of effective translation and development of viable stem cell-based therapies. Particular concerns have been raised over the growing market in unproven cell therapies. In this article, I explore recent developments in the stem cell therapy landscape and argue that while the sale of unproven therapies undoubtedly poses ethical concerns, it must be understood as part of a larger problem at the interface between biomedicine, healthcare, publics, policy and the market. Addressing this will require a broader perspective incorporating the shifting relationships between different stakeholder groups, the global politics of research and innovation, and the evolving role of publics and patients with respect to science.

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group

 2017 Jul 7. doi: 10.5858/arpa.2017-0124-RA. [Epub ahead of print]

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group.

Abstract

CONTEXT:

- Malignant mesothelioma (MM) is an uncommon tumor that can be difficult to diagnose.

OBJECTIVE:

- To provide updated, practical guidelines for the pathologic diagnosis of MM.

DATA SOURCES:

- Pathologists involved in the International Mesothelioma Interest Group and others with an interest and expertise in the field contributed to this update. Reference material included up-to-date, peer-reviewed publications and textbooks.

CONCLUSIONS:

- There was discussion and consensus opinion regarding guidelines for (1) distinguishing benign from malignant mesothelial proliferations (both epithelioid and spindle cell lesions), (2) cytologic diagnosis of MM, (3) recognition of the key histologic features of pleural and peritoneal MM, (4) use of histochemical and immunohistochemical stains in the diagnosis and differential diagnosis of MM, (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas, and squamous cell and renal cell carcinomas), (6) diagnosis of sarcomatoid MM, (7) use of molecular markers in the diagnosis of MM, (8) electron microscopy in the diagnosis of MM, and (9) some caveats and pitfalls in the diagnosis of MM. Immunohistochemical panels are integral to the diagnosis of MM, but the exact makeup of panels employed is dependent on the differential diagnosis and on the antibodies available in a given laboratory. Depending on the morphology, immunohistochemical panels should contain both positive and negative markers for mesothelial differentiation and for lesions considered in the differential diagnosis. Immunohistochemical markers should have either sensitivity or specificity greater than 80% for the lesions in question. Interpretation of positivity generally should take into account the localization of the stain (eg, nuclear versus cytoplasmic) and the percentage of cells staining (>10% is suggested for cytoplasmic and membranous markers). Selected molecular markers are now being used to distinguish benign from malignant mesothelial proliferations. These guidelines are meant to be a practical diagnostic reference for the pathologist; however, some new pathologic predictors of prognosis and response to therapy are also included.