{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:14:00Z","timestamp":1791335640890,"version":"4.3.1"},"reference-count":35,"publisher":"Wiley","issue":"23","license":[{"start":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T00:00:00Z","timestamp":1565136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"International Mesothelioma Program"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The classification of diffuse malignant mesothelioma into epithelioid, biphasic, and sarcomatoid types is based on histologic patterns. The diagnosis is made on biopsies, and because of intratumoral heterogeneity, they may not be representative of the entire tumor. The number and volume of biopsies needed to reach diagnostic accuracy in diffuse malignant mesothelioma and their prognostic value remain unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study examined 759 consecutive patients with pleural diffuse malignant mesothelioma treated by pleurectomy\/decortication or extrapleural pneumonectomy for the presence of epithelioid and\/or sarcomatoid histology and classified both the presurgery biopsies (core\u2010needle or thoracoscopic) and surgical resection specimens. The number and volume of biopsies were correlated with pre\u2010 and postsurgery histologies and overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Diffuse malignant mesothelioma was classified as epithelioid (76%), biphasic (18%), sarcomatoid (5%), or indeterminate (1%) in biopsies and as epithelioid (64%), biphasic (32%), and sarcomatoid (4%) in surgical resection specimens (overall concordance, 80.6%). The positive likelihood ratios were 2.4, 13.6, and 90.1 for biopsies with epithelioid, biphasic, and sarcomatoid histologies, respectively. Concordant histologies between biopsies and resections were associated with a higher number of biopsies (median tissue blocks for concordant histologies vs discordant histologies, 3 vs 2; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.002) but were less associated with a higher volume (median, 1.2 vs 1.1 cm<jats:sup>3<\/jats:sup>; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.06). In a multivariate analysis, overall survival was independently predicted by histology in the resection specimen (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001) but not in the biopsy (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.09).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In contrast to epithelioid histology, sarcomatoid histology in biopsies is highly accurate. Despite intratumoral heterogeneity, the accuracy of histologic classification increases with the number of tissue blocks examined, emphasizing the diagnostic value of extensive sampling by presurgery biopsies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32416","type":"journal-article","created":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T11:45:16Z","timestamp":1565178316000},"page":"4164-4171","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Diagnostic value of biopsy sampling in predicting histology in patients with diffuse malignant pleural mesothelioma"],"prefix":"10.1002","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4383-6938","authenticated-orcid":false,"given":"Lucian R.","family":"Chirieac","sequence":"first","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8568-1591","authenticated-orcid":false,"given":"Yin P.","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Chin","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pathology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias D.","family":"Hofer","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Urology Northwestern University Feinberg School of Medicine Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7234-5652","authenticated-orcid":false,"given":"Paul A.","family":"VanderLaan","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Division of Anatomic Pathology Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William G.","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Sugarbaker","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Bueno","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6608a3"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2016.0087"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181f1cf2b"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6690105"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10408440903044928"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050152"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2015.01.043"},{"key":"e_1_2_8_9_1","first-page":"1","article-title":"International analysis of age\u2010specific mortality rates from mesothelioma on the basis of the International Classification of Diseases, 10th Revision","volume":"4","author":"Boffetta P","year":"2018","journal-title":"J Glob Oncol"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2012-0214-OA"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31815608d9"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(99)70469-1"},{"key":"e_1_2_8_13_1","first-page":"165","volume-title":"Pathology and Genetics of Tumors of the Lung, Pleura, Thymus and Heart","author":"Travis W","year":"2015"},{"key":"e_1_2_8_14_1","first-page":"683","article-title":"Malignant pleural mesothelioma. 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