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Galateau Salle F, Le Stang N, Tirode F, Courtiol P, Nicholson AG, Tsao MS, Tazelaar HD, Churg A, Dacic S, Roggli V, Pissaloux D, Maussion C, Moarii M, Beasley MB, Begueret H, Chapel DB, Copin MC, Gibbs AR, Klebe S, Lantuejoul S, Nabeshima K, Vignaud JM, Attanoos R, Brcic L, Capron F, Chirieac LR, Damiola F, Sequeiros R, Cazes A, Damotte D, Foulet A, Giusiano-Courcambeck S, Hiroshima K, Hofman V, Husain AN, Kerr K, Marchevsky A, Paindavoine S, Picquenot JM, Rouquette I, Sagan C, Sauter J, Thivolet F, Brevet M, Rouvier P, Travis WD, Planchard G, Weynand B, Clozel T, Wainrib G, Fernandez-Cuesta L, Pairon JC, Rusch V, Girard N. Comprehensive Molecular and Pathologic Evaluation of Transitional Mesothelioma Assisted by Deep Learning Approach: A Multi-Institutional Study of the International Mesothelioma Panel from the MESOPATH Reference Center. J Thorac Oncol 2020; 15:1037-1053. [PMID: 32165206 PMCID: PMC8864581 DOI: 10.1016/j.jtho.2020.01.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Histologic subtypes of malignant pleural mesothelioma are a major prognostic indicator and decision denominator for all therapeutic strategies. In an ambiguous case, a rare transitional mesothelioma (TM) pattern may be diagnosed by pathologists either as epithelioid mesothelioma (EM), biphasic mesothelioma (BM), or sarcomatoid mesothelioma (SM). This study aimed to better characterize the TM subtype from a histological, immunohistochemical, and molecular standpoint. Deep learning of pathologic slides was applied to this cohort. METHODS A random selection of 49 representative digitalized sections from surgical biopsies of TM was reviewed by 16 panelists. We evaluated BAP1 expression and CDKN2A (p16) homozygous deletion. We conducted a comprehensive, integrated, transcriptomic analysis. An unsupervised deep learning algorithm was trained to classify tumors. RESULTS The 16 panelists recorded 784 diagnoses on the 49 cases. Even though a Kappa value of 0.42 is moderate, the presence of a TM component was diagnosed in 51%. In 49% of the histological evaluation, the reviewers classified the lesion as EM in 53%, SM in 33%, or BM in 14%. Median survival was 6.7 months. Loss of BAP1 observed in 44% was less frequent in TM than in EM and BM. p16 homozygous deletion was higher in TM (73%), followed by BM (63%) and SM (46%). RNA sequencing unsupervised clustering analysis revealed that TM grouped together and were closer to SM than to EM. Deep learning analysis achieved 94% accuracy for TM identification. CONCLUSION These results revealed that the TM pattern should be classified as non-EM or at minimum as a subgroup of the SM type.
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Affiliation(s)
| | - Nolwenn Le Stang
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France
| | - Franck Tirode
- University Claude Bernard Lyon, INSERM, CNRS, Research Cancer Center of Lyon, Centre Léon Bérard, Lyon, France
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ming-Sound Tsao
- University Health Network, Princess Margaret Cancer Centre and University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| | | | - Andrew Churg
- Columbia University and Department of Pathology Vancouver, Canada
| | - Sanja Dacic
- FISH and Developmental Laboratory at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor Roggli
- Duke University Medical Center, Department of Pathology, Durham, North Carolina
| | - Daniel Pissaloux
- Department of BioPathology-FISH Laboratory, Centre Leon Berard Lyon, France
| | | | | | - Mary Beth Beasley
- Mount-Sinai Medical Center, Department of Pathology, New York, New York
| | - Hugues Begueret
- CHU Bordeaux, Haut Leveque Hospital, Department of Pathology, Bordeaux, France
| | - David B Chapel
- University of Chicago, Department of Pathology, Chicago, Illinois
| | | | - Allen R Gibbs
- University of Wales, Department of Cellular Pathology, Cardiff, United Kingdom
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders University, Adelaide, Australia
| | - Sylvie Lantuejoul
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | | | - Richard Attanoos
- University of Wales, Department of Cellular Pathology, Cardiff, United Kingdom
| | | | | | | | - Francesca Damiola
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France
| | - Ruth Sequeiros
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France
| | - Aurélie Cazes
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; CHU Bichat Department of Pathology, University Paris VII, Paris, France
| | - Diane Damotte
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; CHU Cochin-Hotel Dieu, Department of Pathology, Paris, France
| | - Armelle Foulet
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; CH Le Mans, Department of Pathology, Pays de la Loire, France
| | - Sophie Giusiano-Courcambeck
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; CHU Hospital Nord, Marseille, University Aix-Marseille, Marseille, France
| | - Kenzo Hiroshima
- Tokyo Women's Medical University, Department of Pathology, Tokyo, Japan
| | - Veronique Hofman
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; Mayo Clinic, Scottsdale, Arizona; CHU Nice, Department of Clinical and Experimental Pathology (LPCE), Nice, France
| | - Aliya N Husain
- University of Chicago, Department of Pathology, Chicago, Illinois
| | - Keith Kerr
- Aberdeen Royal Infirmary, Department of Pathology, Aberdeen, Scotland
| | - Alberto Marchevsky
- Scotland Cedars-Sinai Medical Center, Department of Pathology, Los Angeles, California
| | - Severine Paindavoine
- University Claude Bernard Lyon, INSERM, CNRS, Research Cancer Center of Lyon, Centre Léon Bérard, Lyon, France
| | - Jean Michel Picquenot
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; Department of Pathology, Henri Becquerel Centre, Rouen, France
| | - Isabelle Rouquette
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; IUCT-Oncopôle, Department of Pathology, Toulouse, France
| | - Christine Sagan
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; CHU Nantes, INSERM, Thorax Institute, Hôpital Laënnec CHU Nantes, Nantes, France
| | - Jennifer Sauter
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, New York
| | - Francoise Thivolet
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; Hospices Civils, East Hospital Group, Department of Pathology, Lyon, France
| | - Marie Brevet
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; Hospices Civils, East Hospital Group, Department of Pathology, Lyon, France
| | - Philippe Rouvier
- CHU Pitié Salpétrière Paris, Department of Pathology, Paris, France
| | - William D Travis
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, New York
| | - Gaetane Planchard
- MESOPATH, MESONAT, MESOBANK Department of BioPathology Centre Leon Berard, Lyon, France; Department of Pathology, CHU Caen, Caen, France
| | | | | | | | - Lynnette Fernandez-Cuesta
- Genetic Cancer Susceptibility Group International Agency for Research on Cancer World Health Organization, Lyon, France
| | - Jean-Claude Pairon
- INSERM, UPEC, Faculty of Medicine and CHI Creteil, Professional Pathologies and Environment Department, IST-PE, Creteil, France
| | - Valerie Rusch
- Memorial Sloan Kettering Cancer Center, Department of Thoracic Surgery, New York, New York
| | - Nicolas Girard
- Department of Thoracic Oncology Institute Curie Paris, France and European Reference Network EURACAN, Centre Leon Berard, France
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