Brussels april 2, 2011 Brussels april 2, 2011 Mesothelioma: Diagnosis and treatment Mesothelioma: Diagnosis and treatment 4th anniversary of AsbeBstos Fund 4th anniversary of AsbeBstos Fund French Mesothelioma Register. An International collaboration on mesothelioma Detection of early lesions
Chronology of asbestos expertise network (MESOPATH) The French Programme National de Surveillance du Mésothéliome 2006 1972 1995 1998 2009 2011 MESOPATH MESOPATH- PNSM MESONAT MESOPATH-IM@EC College of Register DOB Panel International des Label by INCA Pathologists Mésothéliomes Label by the National referent Center Pr J Chretien Standardized procedure French National « Pleural mesothelioma Pr J Bignon Committee of of pathological and rare peritoneal Dr J Nebut certification tumors » (All french Register collaboration with districts + Noumea) (22 districts) . INVs [french NIH] national expertise & All cases are International super 22 districts certified by expertise using a system MESOPATH with e@pathology and All cases are certified Group of virtual slides by MESOPATH group of experts before experts before registration registration Grants (1998-2010) : INVs-DST INVs-DMCT INCa
Background Background Metintas M, et al. o To date , despite the improved accuracy of Eur J Radiology 2002; 41: 1-9 new chest–imaging modalities, tissue biopsy confirmation is required to is required to establish a diagnosis of malignant establish a diagnosis of malignant mesothelioma. mesothelioma. By courtesy of P. Astoul o Current state and future directions of pleural mesothelioma imaging [IMIG 2006] . No single, conventional imaging approach captures the information necessary to direct all aspects of patient management Armato et al, Lung Cancer. 2008.
Background Background By courtesy A. Jehan metastasis o DMM is a very heterogeneous disease and a great mimicker of primary and metastatic neoplasms affecting the pleura as well as of by courtesy benign / reactive lesions. T. Colby mesothelioma o Difficult to compare results of various treatment approaches because of problems in accurate staging, errors in diagnosis and lack of new mesothelioma prognostic factors. By courtesy mesothelioma S. Hammar
2009 Lille Copin MC MESOPATH- IM@EC Rouen Piquenot JM- Galateau-Sallé Caen Nancy AP-HP Vignaud JM Foulet A- Abd –Alsamad I Centre de Le Mans référence Capron F Danel C Réseau Groussard O - Nantes MESOPATH de Lajarte Y Thivolet F- Sagan C Lyon Grenoble Brambilla E- Bordeaux Lantuejoul S Begueret H TOM: Marseille • Nouméa Nouvelle Calédonie Rouleau v Garbe L
Methods : Pathology and clinical confirmation Methods Standardized diagnostic confirmation procedures • For each case: samples transmitted to the “Mesopath” french meso panel (national group of specialized pathologists) • Cases classified as certain, uncertain, unclassified (because of inadequate material) or ruled it out in favour of other diagnosis. • A supplemental immunohistochemical analysis of 2 +ve and 2 –ve markers is undergone to maximise the reliability of the diagnosis • When a case can not be confirmed pathologically: clinical assessment by two pneumoconiosis specialists one radiologist.
Procedure of pathological Certification Methods Initial pathologist diagnosis 3 experts blindly reviewed the slides (WHO classification 2004) Additional Ipox (2 +ve and 2 - ve markers for mesothelial cells) without the knowledge of asbestos exposure or clinical information Agreement Disagreement Agreement Excluded Mesothelioma mesothelioma Monthly collective expertise diagnosis diagnosis (quorum 10 experts) Uncertain Excluded Mesothelioma mesothelioma mesothelioma diagnosis diagnosis diagnosis
International Mesothelioma Excellence Center Background Allen T Allen T Attanoos R Attanoos R Brambilla E Brambilla E Borszuck A Borszuck A Cagle P Cagle P Churg A Churg A Colby T Colby T Dacic S Dacic S Fukuoka J Fukuoka J Galateau Salle F Galateau Salle F Gibbs A Gibbs A Hammar S Hammar S Hasleton P Hasleton P Henderson D Henderson D Husain A Husain A Inai K Inai K Kerr K Kerr K Popper H Popper H Praet Marlene Praet Marlene Roggli V Roggli V Travis WD Travis WD Vignaud JM Vignaud JM
International mesothelioma excellence center Objectives 1) For diagnosis Missions to serve as a group of experts, examine and diagnose difficult cases sent to the IMP from anywhere in the world through one of the experts to report as a group of experts a consensus diagnosis to the pathologist.
International mesothelioma excellence center Objectives For education Initiate an international collection and database of cases for academic and research purposes for the international community. Missions to publish white papers or position papers and guidelines under the auspices of scientific society ( CAP/ INCA/ SFP/AIP) to perform e@pathology education For research To improve opportunities for internationally-cooperative research To select cases from the consensus expertise and guarantee a high quality of diagnosis. To prepare a catalogue of cases
Legal framework of the IM@EC • French Public health code Art. L. 6143-7- 3 • IM@EC center of Excellence created under an academic hospital [CHU] GCS under an ethics authority, for the performance of research activities for the general benefit of the community.
Since 1998 MESOPATH-missions Standardized procedure of pathological diagnostic certification To Improve pathological knowledge of mesothelioma International Mesothelioma panel To evaluate immnuohistochemical markers
Since 2006 Mesopath missions o To improve the assessment of incidence analyzed by the PNSM oTo perform survival analysis oTo analyse unusual variants Registration since 1998 Population (22 districts) 18 million inhabitants 30% of the French population
National Referent center for pleural mesothelioma and rare peritoneal tumors Since 2009 Mesopath missions -Care pathway 2nd LECTURE To Improve inclusion of pts in therapeutic protocole TOM: Write up Guidelines • Nouméa Nouvelle Calédonie Research activities
About us Researchers MESOPATH France MESOPATH France IM@EC International IM@EC International F Galateau Salle- chair F. Galateau-Salle -Chair Paciencia M Brevet M Karanian M Secretary: Secretary: Qualitician Saguet V Hoyez J Blaizot G Leval M Planchard G Lenouares C Clinical Research Technicians Molecular Technicians immuno Technicians immuno Assistant Leblanc S Ingeneer Abonnet V Petit MC Chene Y Drougard C MESONAT MESONAT MESOBANK MESOPATH NRC MESOPATH PNSM PLATFORM MESOPATH NRC MESOPATH PNSM PLATFORM Statistician: N Le Stang Virtual multicentric Head project Clarebout G Monitoring of data Monitoring of data of of Investigator: Blaizot G National tissue bank Monitoring of data De Quillacq A Virtual slides system Monitoring of data Virtual slides system monitoring of data: Phd Clarebout G De Quillacq A Paciencia M Engineer: Rousvoual T De Quillacq A Ingeneer Abonnet V Paciencia M Planchard G Saguet V Karanian M
INSERM ERI 3 ‘’Cancers & Populations
Avancée de l’expertise pour les cas en cours par année de réception Bilan au 15 décembre 2010 Année de réception du prélèvement pleural PNSM Etape 2007 2008 2009 2010 Total d’expertise N % N % N % N % N % Relus par 1 5 2 6 2 18 5 117 51 146 12 expert Relus par 2 184 60 165 62 218 60 71 31 638 55 experts Relus par 3 29 9 10 4 13 4 6 2 58 5 experts Passés en 90 29 84 32 111 31 37 16 322 28 consensus Total 308 100 265 100 360 100 231 100 1164 100 Délai moyen de lecture Année de réception du prélèvement pleural ou péritonéal (cas 2007-2010) : 20 jours hors PNSM Etape d’expertise 2007 2008 2009 2010 Total PNSM : 16 jours N % N % N % N % N % Hors PNSM : 22 jours Relus par 1 expert 5 1 6 2 18 4 117 40 146 9 Relus par 2 184 47 165 43 218 48 71 24 638 42 Expertise finale 107 jours ~3,5 experts Relus pas 3 mois 29 7 10 3 13 3 6 2 58 4 experts Passés en Expertise finale FIVA : 54 jours 176 45 199 52 206 45 100 34 681 45 consensus ~2 mois Total 394 100 380 100 455 100 294 100 1523 100
Activités de recherche Images virtuelles et MESOBANK MESOPATH MESOPATH IM@EC IM@EC Plateforme Plateforme Lames virtuelles Lames virtuelles MESOPATH- MESOPATH- MESOPATH- MESOPATH- MESOBANK MESOBANK MESONAT Pr A. Elmoataz MESONAT Pr A. Elmoataz PNSM CNR Tissus cellules PNSM CNR Tissus cellules Dr H. Elie Dr H. Elie M.Lecluse M.Lecluse MESOBANK MESOBANK Lignées cellulaires Lignées cellulaires MC JAURAND MC JAURAND D JEAN D JEAN INSERM U 674 INSERM U 674
Pr A. Elmoataz
Centre Hospitalier Public du Cotentin Cherbourg - GREYC Université Caen VALTRICYT VALidation du TRi cellulaire Informatisé en Cytopathologie Tumorale Projet CHRU-CHPC-GREYC MESOPATH Dr H. Elie et M Lecluse CHRU CAEN Diagnostic de l’hyperplasie mésothéliale atypique dans les produits d’épanchements pleuraux. Étude en cytomètrie par analyse d’images, en immuno-histochimie et en biologie moléculaire (recherche de la délétion de p16 INK4a par FISH ).
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