Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura

Our plain-English summary of Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura, by C. González-Lois, C. Ballestín, M.T. Sotelo, et al (Histopathology, 2001).

The study

• Authors: C. González-Lois, C. Ballestín, M.T. Sotelo, F. López-Ríos, M.D. García-Prats, V. Villena
• Journal: Histopathology
• Published: 2001;38(6):528-34
• Cited by: 39 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: To determine the value of immunohistochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy we optimized a double panel of MOC-31 and HBME-1 and compared the results with others from the literature.

Methods And Results: A multi-antibody panel was applied to biopsy samples from 44 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura. We used monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber-EP4, carcinoembryonic antigen (CEA), tumour-associated glycoprotein (B72.3), LeuM1, vimentin, desmin, epithelial related antigen (MOC-31) and mesothelial cell (HBME-1). Positivity for MOC-31 and Ber-EP4 was found to have the highest nosologic sensitivity (94.1% and 84.6%, respectively) and specificity (86.3% both antibodies) for carcinoma. Positive staining for HBME-1 and vimentin had the highest sensitivity (90.9% and 100%, respectively) and specificity (91.3% and 60%, respectively) for mesothelioma. A two-marker antibody panel with HBME-1 and MOC-31 was the most efficient for the distinction between carcinoma and malignant pleural mesothelioma.

Conclusion: A combination of MOC-31 (an anti- epithelial marker) and HBME-1 (an anti-mesothelial marker) has a diagnostic efficiency of 76.1% for the distinction between carcinoma and mesothelioma in pleura.

In plain English

This study, from a hospital pathology department in Madrid, tested which laboratory stains (immunohistochemical markers) best distinguish malignant pleural mesothelioma from carcinomas that have spread to the pleura, the lining around the lungs. The authors stained pleural biopsies from 44 mesotheliomas diagnosed at the hospital between 1993 and 1998 and 23 metastatic carcinomas from the same period. Four of the 44 mesothelioma patients had certain asbestos exposure; the study did not examine exposure further. No single marker separated the two cancers on its own. The marker MOC-31 was reported as 94.1% sensitive and 86.3% specific for carcinoma, and HBME-1 as 90.9% sensitive and 91.3% specific for mesothelioma. Used together, the pair resolved 51 of 67 cases (76.1%). No mesothelioma was MOC-31 positive and HBME-1 negative, and no carcinoma showed the reverse pattern. Adding more markers resolved no further cases. The authors concluded that the two-marker panel is very effective as a first step, and that unresolved cases need further tests. Some figures in the article's tables do not agree with each other.

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: Single-hospital diagnostic study comparing immunohistochemical staining of stored pleural biopsy samples, with a comparison against published series
• Who was studied: Pleural biopsies from 44 malignant pleural mesotheliomas, drawn from the 47 diagnosed at Doce de Octubre University Hospital, Madrid, between 1993 and 1998, and 23 carcinomas metastatic to the pleura, randomly selected from the same period. Cases lacking enough tissue were excluded: 3 mesotheliomas and 2 of 25 carcinomas. Of the 44 mesotheliomas, 35 were epithelioid, 7 sarcomatous, 1 biphasic and 1 lymphohistiocytoid.
• Exposure: Not an asbestos exposure study. What was tested was staining with monoclonal antibodies, chiefly MOC-31 and HBME-1, alongside keratins, vimentin, desmin, Ber-EP4, CEA, B72.3 and LeuM1. The article notes that four of the 44 mesothelioma patients had certain asbestos exposure.
• Main results:
  • For carcinoma, MOC-31 was reported as 94.1% sensitive and Ber-EP4 as 84.6% sensitive, with 86.3% specificity for both.
  • For mesothelioma, HBME-1 was 90.9% sensitive and 91.3% specific, and vimentin was 100% sensitive and 60% specific.
  • A MOC-31-positive, HBME-1-negative result was 100% specific and 73.9% sensitive for carcinoma.
  • A MOC-31-negative, HBME-1-positive result was 100% specific and 77.2% sensitive for all the malignant pleural mesotheliomas, and 77.1% sensitive for epithelial mesotheliomas.
  • The MOC-31 and HBME-1 pair resolved 51 of 67 cases (76.1%), or 44 of 58 (75.8%) counting only epithelioid mesotheliomas. This was more than any other two-marker combination.
  • Combinations of more than two markers did not resolve any additional cases.
• The authors' conclusion: The authors concluded that the simple MOC-31 and HBME-1 double panel is very effective for the differential diagnosis of malignant pleural tumours and should be the first step.
• Limitations the authors state:
  • The authors noted that cases the two-marker panel did not resolve would need more antibodies and other ancillary techniques.

Topics

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

Medical terms in this study, explained in our Lexicon: MOC-31, HBME-1, Mesothelioma, Carcinoma, Pleura, Immunohistochemistry, Pleural Mesothelioma, Pleural Biopsy.

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