Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry

Our plain-English summary of Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry, by X.Y. Su, G.D. Li, W.P. Liu, et al (Diagnostic Cytopathology, 2011).

The study

• Authors: X.Y. Su, G.D. Li, W.P. Liu, B. Xie, Y.H. Jiang
• Journal: Diagnostic Cytopathology
• Published: 2011;39(12):900-8
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The objective of the study is to estimate the expression of some antibodies in the metastatic adenocarcinomas, malignant epithelial mesotheliomas, and reactive mesothelial cells in serous effusions and to choose effective panel to the differential diagnosis. Totally 113 effusion cytology samples (80 pleural fluid, 30 ascitic, and 3 pericardial fluid) from 60 cases of metastatic adenocarcinoma (ACA), 18 cases of malignant epithelial mesothelioma (MM), and 35 cases of reactive mesothelium (RM) were included in this study. The cytological diagnoses of these cases were confirmed by histopathology or clinical datas. Smears and cell blocks were prepared for each case. Immunocytochemical study was performed on the cell block sections. The sensitivity of E-cadherin, CEA, MOC-31, and Ber-EP4 for adenocarcinoma was 86.7%, 80%, 70%, and 76.4%, respectively. The specificity was 98.1%, 96.2%, 92.5%, and 86.8%, respectively. The sensitivity of calretinin, HBME-1, and thrombomodulin for RM/MM was 83%, 79.2%, and 47.2% respectively. The specificity was 88.3%, 21.7%, and 70%, respectively. The expression of E-cadherin, CEA, MOC-31, Ber-EP4, calretinin, and thrombomodulin showed significant difference between ACA and RM/MM (P < 0.01). The reactivity of EMA and Des showed significant difference between RM and MM (P < 0.01). In our opinion, the antibody panel that consists of E-cadherin, CEA, calretinin, and thrombomodulin should be the best for differential diagnosis between metastatic adenocarcinomas and RM/MM in serous effusions. EMA and Des should be used to differentiate malignant epithelial mesothelioma and reactive mesothelial cells. EMA positive and Des negative favor MM, while Des positive and EMA negative favor RM.

Copyright © 2010 Wiley Periodicals, Inc.

In plain English

This laboratory study from West China Hospital, Sichuan University, tested antibody stains on cell blocks made from 113 fluid samples from around the lungs, abdomen or heart. The samples came from 60 cases of adenocarcinoma that had spread from elsewhere, 18 cases of malignant epithelial mesothelioma, and 35 cases of non-cancerous "reactive" lining cells. The article does not discuss asbestos. For detecting adenocarcinoma, E-cadherin had a sensitivity of 86.7% (52/60) and a specificity of 98.1%. CEA had 80% and 96.2%, and the two together detected 96.7% (58/60). For detecting mesothelial cells (mesothelioma and reactive cells grouped together), calretinin had 83.0% sensitivity and 88.3% specificity, while HBME-1 had 21.7% specificity. EMA stained 17 of 18 mesotheliomas and 8 of 35 reactive samples. Des stained 3 of 18 mesotheliomas and 28 of 35 reactive samples. Both differences had P less than 0.01, and P53 showed no significant difference. The authors concluded that E-cadherin, CEA, calretinin and thrombomodulin formed the best panel against adenocarcinoma, and that EMA and Des should be used to separate mesothelioma from reactive cells.

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: Diagnostic laboratory study comparing immunocytochemical (antibody) stains on cell blocks from body-fluid (effusion) samples
• Who was studied: 113 effusion cases from the Department of Pathology, West China Hospital of Sichuan University (80 pleural, 30 peritoneal, 3 pericardial effusions): 60 metastatic adenocarcinoma, 18 malignant epithelial mesothelioma, 35 reactive mesothelium. The reactive cases came from tuberculosis (20), cirrhosis (5), cardiac failure (5) and pneumonia (5). No study dates are given.
• Exposure: Not addressed. The article does not mention asbestos or any patient exposure. What was studied was the staining of ten antibodies (E-cadherin, CEA, MOC-31, Ber-EP4, calretinin, HBME-1, thrombomodulin, EMA, Des, P53).
• Main results:
  • E-cadherin for adenocarcinoma: sensitivity 86.7% (52/60), specificity 98.1% (printed as 52/53)
  • CEA for adenocarcinoma: sensitivity 80% (48/60), specificity 96.2% (51/53)
  • E-cadherin combined with CEA was positive in 96.7% (58/60) of adenocarcinomas
  • MOC-31 for adenocarcinoma: sensitivity 70% (42/60), specificity 92.5% (49/53)
  • Ber-EP4 for adenocarcinoma, tested in only some cases (55 adenocarcinomas, 38 mesothelial cases): sensitivity 76.4% (42/55), specificity 86.8% (33/38)
  • Calretinin for mesothelioma and reactive mesothelium combined: sensitivity 83.0% (44/53), specificity 88.3% (53/60)
  • HBME-1 for mesothelioma and reactive mesothelium combined: sensitivity 79.2% (42/53), specificity 21.7% (13/60)
  • HBME-1 staining could not be shown to differ significantly between adenocarcinoma, mesothelioma and reactive mesothelium
  • Thrombomodulin for mesothelioma and reactive mesothelium combined: sensitivity 47.2% (25/53), specificity 70% (42/60)
  • EMA was positive in 22.9% (8/35) of reactive mesothelium cases and 94.4% (17/18) of mesotheliomas
  • Des was positive in 80% (28/35) of reactive mesothelium cases and 16.7% (3/18) of mesotheliomas
  • EMA and Des staining differed significantly between mesothelioma and reactive mesothelium (P less than 0.01)
  • The pattern EMA positive with Des negative was seen in 83.3% (15/18) of mesotheliomas and in 5.7% (2/35) of reactive mesothelium cases
  • P53 was positive in 85.7% (30/35) of reactive mesothelium cases and 94.4% (17/18) of mesotheliomas. The difference could not be shown to be significant.
• The authors' conclusion: The authors concluded that a panel of E-cadherin, CEA, calretinin and thrombomodulin was best for telling metastatic adenocarcinoma from mesothelioma or reactive mesothelial cells in effusions. They also concluded that EMA and Des should be used to tell malignant epithelial mesothelioma from reactive mesothelial cells.

Topics

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

Medical terms in this study, explained in our Lexicon: Differential Diagnosis, Adenocarcinoma, Mesothelioma, Reactive Mesothelial Cells, Cytology, Pericardial, Mesothelium, Histopathology.

Related studies

• MMP-7 is a highly specific negative marker for benign and malignant mesothelial cells in serous effusions — B. Davidson, H.T. Stavnes, et al. (2016)
• Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers — B. Davidson, B. Risberg, et al. (1999)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)
• Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations — K. Ikeda, G. Tate, et al. (2011)
• Utility of HBME-1 immunostaining in serous effusions — V. Ascoli, C. Carnovale-Scalzo, et al. (1997)
• The importance of EZH2 and MOC-31 expression in the differential diagnosis of benign and malignant effusions — C. Sadullahoglu, D. Nart, et al. (2017)

Browse more research in Diagnostic Cytopathology, or return to medical research.