Background: Diffuse malignant peritoneal mesothelioma (DMPM) is the most common histological type of peritoneal mesothelioma (PM). Accurate histology and Ki67 assessment are crucial for treatment and prognosis, yet intra-tumoral heterogeneity may hinder preoperative diagnostics. A standardized diagnostic pathway is lacking. This study evaluates factors influencing the diagnostic accuracy on Ki67 and sarcomatoid component.
Materials and Methods: This retrospective study analysed 98 patients (2008–2022). Concordance between preoperative and post-CRS-HIPEC histological subtype and Ki67-class (≤9% vs. >9%) was estimated using the k-index. Fisher’s exact test assessed the impact of biopsy type (core-needle vs. surgical), biopsy number (single vs. multiple), and specimen quantity (slides and blocks) on histotype and Ki67 concordance. Diagnostic performance was evaluated for both core-needle and surgical biopsy.
Results: Concordance was moderate for Ki67 (k-index=0.4) and optimal for histotype (k-index=0.8). No significant differences were found between biopsy types for histotype (p=0.60) or Ki67 (p=1.00). Diagnostic accuracy was unaffected by biopsy number (p=0.16 histotype, p=0.50 Ki67) or volume (p=0.30 histotype, p=0.60 Ki67). Surgical biopsy had Sensibility (Se)=80%, Specificity (Sp)=98%, Positive Predictive Value (PPV)=80%, Negative Predictive Value (NPV)=98% for sarcomatoid identification, and Se=86%, Sp=82%, PPV=79%, NPV=88% for Ki67. Core-needle biopsy showed Se=60%, Sp=100%, PPV=100%, NPV=50% for Ki67.
Conclusions: Surgical biopsy remains the current gold standard for PM diagnosis, but core-needle biopsy could be considered for lesions accessible via interventional radiology.
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