About the diagnostic value of BAP-1 antibody in malignant pleural mesothelioma: a meta-analysis

Our plain-English summary of About the diagnostic value of BAP-1 antibody in malignant pleural mesothelioma: a meta-analysis, by M. Mlika, M. Zorgati, M. BenKhelil, et al (Journal of Immunoassay & Immunochemistry, 2019).

The study

• Authors: M. Mlika, M. Zorgati, M. BenKhelil, F.E. Mezni
• Journal: Journal of Immunoassay & Immunochemistry
• Published: 2019;40(3):269-282
• Type of article: Meta-analysis
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The positive diagnosis of MPM is based on morphologic features coupled with immunohistochemical findings. Many antibodies have been published especially in order to differentiate between malignant tumors and atypical mesothelial hyperplasia. BAP-1 is a BRCA1-binding protein whose loss of expression was frequently reported in MPM. Our aim was to assess the diagnostic value of this antibody in comparison to the most sensitive diagnostic antibody represented by the calretinin antibody.

Methods: We performed a meta-analysis using the Meta-Disc software 5.1.32.

Results: According to our inclusion criteria, 19 studies with 11 studies dealing with BAP1 antibody and 8 studies dealing with calretinin antibody were included. The SEN of BAP 1 and calretinin antibodies was respectively estimated to 54.6% and 86.5%. The SPE reached respectively 95.7% and 76.6%. The dOR was estimated respectively to 23.664 and 38.8. The I-square revealed a heterogeneity of the parameters studied. The metaregression analysis revealed as covariates the amplification system and the histologic subtype as causing effects of heterogeneity for BAP1 antibodies and histologic subtype and chromogene as causing effects of heterogeneity for calretinin antibody.

Conclusion: This meta-analysis revealed that BAP1 antibody should be associated with more sensitive antibodies in order to assess the diagnosis.

In plain English

This article was a meta-analysis pooling published studies. The authors searched PubMed, Embase and the Cochrane Library for studies from 2007 to November 2018 on two stains used to diagnose malignant pleural mesothelioma: BAP1, which points toward mesothelioma when tumor cells lose it, and calretinin. They included 14 articles and 1 abstract, counted as 19 studies: 11 on BAP1 and 8 on calretinin. Pooled across studies, BAP1 correctly flagged 54.6% of mesotheliomas (sensitivity; 95% confidence interval printed as 51.2 to 71.6). It correctly ruled out mesothelioma in 95.7% of comparison samples (specificity; interval printed in reverse, as 97.1 to 93.9). For calretinin, sensitivity was 86.5% and specificity 76.6% (intervals 84.1 to 88.7 and 73.3 to 81.5). Results varied widely between studies. The analysis linked this variation to the amplification system and tumor subtype for BAP1, and to the chromogen (the color-producing chemical) and tumor subtype for calretinin. The authors concluded that BAP1 is not a perfect marker alone but can be useful combined with more sensitive markers such as calretinin. The article did not study asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: meta-analysis of published diagnostic accuracy studies, following PRISMA guidelines
• Who was studied: Published studies, searched in PubMed, Embase and the Cochrane Library from 2007 to November 2018 (French and English only). The studies tested BAP1 and/or calretinin staining on malignant pleural mesothelioma and on comparison conditions, such as reactive mesothelial hyperplasia and various carcinomas. 14 articles and 1 abstract were included, counted as 19 studies: 11 on BAP1 and 8 on calretinin.
• Exposure: Not an asbestos exposure study. The tests examined were immunohistochemical staining with BAP1 antibody (diagnostic when not expressed by tumor cells) and with calretinin antibody.
• Main results:
  • BAP1 studies: pooled sensitivity was 54.6% (95% CI printed as 51.2 to 71.6).
  • BAP1 studies: pooled specificity was 95.7% (95% CI printed in reverse order, as 97.1 to 93.9).
  • BAP1 studies: pooled diagnostic odds ratio was 23.664 (95% CI 10.129 to 55.285). The area under the SROC curve was 0.9.
  • Calretinin studies: pooled sensitivity was 86.5% (95% CI 84.1 to 88.7).
  • Calretinin studies: pooled specificity was 76.6% (95% CI 73.3 to 81.5).
  • Calretinin studies: pooled diagnostic odds ratio was 38.8 (6.34 to 237.66). The area under the SROC curve was 0.94.
  • BAP1 studies: heterogeneity between studies was substantial (I-square 87.3% for sensitivity). Meta-regression showed significant effects of the amplification system (p = 0.0013) and of mesothelioma subtype (p = 0.0387).
  • Calretinin studies: meta-regression showed significant effects of the chromogen (p = 0.03) and of mesothelioma subtype (p = 0.017). Clone and amplification system had no significant effect.
• The authors' conclusion: The authors concluded that BAP1 does not seem to be the perfect diagnostic antibody for malignant pleural mesothelioma, but that it can be useful when combined with more sensitive antibodies such as calretinin.
• Limitations the authors state:
  • The included studies did not report the number, size and nature of the specimens. This may have led to underestimating the sources of heterogeneity.
  • The effect of specimen type could not be assessed in this meta-analysis.
  • Heterogeneity was present across all BAP1 and calretinin studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Meta-Analysis, Atypical Mesothelial Proliferation, Calretinin, BAP1, Histological Subtype.

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