Survey of British pathologists' performance of mesothelioma post-mortems

We analyzed the practice of mesothelioma post-mortems in the United Kingdom (UK). Between 2003 and 2004, a questionnaire was sent to all UK Consultant Histopathologists, and 12% were recruited. In general post-mortems, the Coroner approved 60% of requests for organ retention, and Pathologists failed to make such a request in 5.9% of cases. In asbestos cases, the lungs were not fixed for sampling in 54.8% of cases, owing to the Coroners' refusal in 46.4% and the pathologists' failure to make a request in 8.4% of cases. In epithelioid mesothelioma, mesothelial and epithelial stains were considered to be of similar importance, and calretinin was the most popular individual stain. In sarcomatoid mesothelioma, mesothelial stains were chosen by 45.9% of pathologists, cytokeratin by 18.7% and epithelial stains by 18.5%. Calretinin was the most popular stain. Accurate mesothelioma diagnosis is impeded by the lack of tissue being made available by the Coroner and failure of some pathologists to make requests. Pathologists use appropriate immunohistochemical testing in epithelioid mesothelioma. In sarcomatoid mesothelioma, epithelioid stains were popular but have limited use. The Coroner should approve more requests for organ retention, and information should be disseminated to pathologists regarding best practice in mesothelioma.