Discordance between cardiopulmonary physiology and physical therapy.

were CEA negative and Leu-M1 or B72.3 positive have been reported. These latter two antibodies were not used by the authors. Furthermore, ultrastructural studies have been found useful by a number of authors,22 6 but were not employed in the study by Beuachamp et al,t Some ofthese tests may not have been performed due to the limitation of the sample size. This merely serves to underscore the diagnostic limitations of closed-needle biopsy of the pleura. It has been my experience that needle biopsy of the pleura is only occassionally sufficient to make an unequivocal premortem diagnosis of malignant mesotheliomaa 2 and then only after careful correlation with clinical and radiographic features. The study by Beauchamp et alt does not refute that position, and the readers of Chest should not conclude that closed-needle biopsy in most cases provides the pathologist with sufficient material to make this oftentimes difficult diagnostic distinction. KF. The role of closed pleural needle biopsy in the diagnosis of malignant mesothehioma of the pleura. SD, et al. Diagnosis of diffuse malignant mesotheli-oma: experience of a US/Canadian mesothelioma panel.dotumors of the serous membranes. We appreciate the comments of Dr. Roggli and agree with him that closed-needle biopsy is not always sufficient to make the diagnosis of malignant mesothelioma of the pleura. There is no single diagnostic test, pathologic or otherwise, for malignant mesothelioma of the pleura. Some biopsy samples will require more pathologic testing than others to help separate malignant mesothelioma from am adenocarcinoma. However, not all biopsy samples require all pathologic tests to be performed on them for a diagnosis to be made. The histochemical stains Alcian blue and colloidal iron can be positive in both malignant mesothelioma and adenocarcinoma. In malignant mesothelioma, Alcian blue and colloidal iron can stain positive due to their reaction with hyaluronic acid. In adenocarci-noma, Alcian blue and colloidal iron can stain positive due to their reaction with chondroitin sulfate. Hyaluronidase can be used to help separate the two. Exposure of the tissue to hyaluronidase will digest hyaluronic acid present in a mesothelioma; on subsequent exposure to Alcian blue or colloidal iron, the mesothelioma will fail to stain. However, hyaluronidase will not digest the chondroitin sulfate present in adenocarcinoma; on subsequent exposure to Alcian blue or colloidal iron the adenocarcinoma will still result in a positive reaction. There are many antibodies available for use in immunohistochemi-cal testing to differentiate malignant mesothelioma from adenocar-cinoma. …