Update on pleural epithelioid mesothelioma: New insights for diagnosis and patient management
Cet article passe en revue les avancées récentes sur les biomarqueurs pour le diagnostic et la prise en charge thérapeutique d'un mésothéliome pleural épithélioïde
Diffuse Mesothelioma is typically diagnosed through histopathologic evaluation. Recent advances in therapeutic strategies have heightened the importance of accurate diagnosis and subtyping. In addition to the three well-established histological subtypes of mesothelioma (epithelioid, biphasic and sarcomatoid), the 2021 WHO classification of diffuse pleural mesothelioma [DPM] emphasizes the importance of subtyping patterns and cytological features to improve clinical diagnosis and patient management. Notably, the presence of a solid component or pleomorphic cytological features observed within the epithelioid subtype is associated with a worse prognosis, approaching that of a sarcomatoid mesothelioma. Conversely, cases with abundant myxoid stroma and a solid component comprising less than 50% are associated with an improved survival. In addition, a two-tiered grading system (low vs. high grade) is now recommended for epithelioid mesothelioma. On behalf of IASLC Mesothelioma Sub-Committee of the Rare Tumor Group and Pathology Committee, we herein outline what is new to assist clinicians essential for optimizing the management of patients with mesothelioma. This includes practical questions on immunohistochemical and molecular markers BAP1, MTAP, NF2 and fusion genes, that are relevant to the diagnosis, prognosis and application of emerging therapeutic strategies in DPM. This discussion also addresses frequently asked questions by clinicians regarding sampling modalities aimed at optimizing diagnostic accuracy. The impact of epigenetics, DNA methylation and biomarker discovery is highlighted, with an emphasis on its limitations in distinguishing mesothelioma versus reactive mesothelial proliferations and other neoplastic mimics. The emerging role of Artificial Intelligence in subtyping, grading and prediction of biomarkers for genomic subtyping is also discussed.
Journal of Thoracic Oncology , résumé, 2026