Differential reactivities of carcinoembryonic antigen (CEA) and CEA-related monoclonal and polyclonal antibodies in common epithelial malignancies

Our plain-English summary of Differential reactivities of carcinoembryonic antigen (CEA) and CEA-related monoclonal and polyclonal antibodies in common epithelial malignancies, by K. Sheahan, M.J. O'Brien, B. Burke, et al (American Journal of Clinical Pathology, 1990).

The study

• Authors: K. Sheahan, M.J. O'Brien, B. Burke, P.A. Dervan, J.C. O'Keane, L.S. Gottlieb, N. Zamcheck
• Journal: American Journal of Clinical Pathology
• Published: 1990;94(2):157-64
• Cited by: 91 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To evaluate the role of carcinoembryonic antigen (CEA) in solving problems of tumor histogenesis in surgical pathology, monoclonal antibodies to four distinct epitopes of CEA (E-Z-EM) were applied to paraffin sections of 303 epithelial neoplasms from multiple sites. Two epitopes were CEA specific (D14 and B7.1), one was shared with nonspecific cross-reacting antigen (NCA) (B7.8), and the fourth (B18) was common to CEA, NCA, and biliary glycoprotein antigen (BGP). A sample of the tumors (n = 110) was also stained with a polyclonal anti-CEA (DAKO). Gastrointestinal adenocarcinomas, including esophageal and gastric (n = 19), small intestinal (n = 8), colorectal (n = 56), biliary tract (n = 8), and pancreatic adenocarcinomas (n = 14), were consistently positive with all five antibodies. Other predominantly gland-forming carcinomas tested, comprising lung (n = 22), ovary (n = 18), and endometrium (n = 12), were either invariably negative with all five antibodies (endometrial adenocarcinoma, non-mucinous ovarian adenocarcinoma) or demonstrated selective and variable positivity (lung: D14, 50%; ovarian mucinous: D14, 50%). Among large polygonal cell carcinomas (hepatocellular carcinoma, renal cell carcinoma, melanoma, and adrenal carcinoma), only hepatomas stained positively, showing a distinctive canalicular staining pattern with the B18 (BGP epitope) (55%) and polyclonal antibody (50%). In the small polygonal cell carcinoma category, true CEA positivity was rare in breast (D14, 10% and B7.1, 14%) and never seen in prostatic carcinomas and carcinoid tumors. A subset of these breast (8 of 42), prostate (4 of 22), and carcinoids (4 of 7) showed exclusive positivity for the B18 antibody (NCA/BGP epitope). Ovarian serous papillary carcinomas (n = 14), papillary carcinomas of thyroid (n = 12), transitional cell carcinomas of the bladder (n = 11), and mesotheliomas (n = 3) were negative with all monoclonal antibodies. Metastatic carcinomas (n = 74) showed a similar pattern of reactivity to primary tumors. The authors conclude that CEA immunostaining may assist in identifying the histogenesis of epithelial tumors in several morphologic categories; that differential reactivities of the CEA monoclonal antibody panel exceed those of the polyclonal antibody; and that the discriminating power of the monoclonal panel is related to whether (1) CEA is or is not produced or (2) NCA or BGP is produced without concomitant CEA production. There is little evidence to support a concept of site-specific CEA species.

In plain English

This laboratory study tested whether staining tumor tissue for carcinoembryonic antigen (CEA), a protein made by some cancers, helps pathologists tell where a tumor started. The authors stained 303 carcinomas from many body sites, plus 7 melanomas, 3 mesotheliomas and 7 carcinoid tumors, from pathology files in Boston and Dublin. They used four monoclonal antibodies (two specific for CEA, two also detecting related proteins) and, on 110 tumors, a polyclonal antibody. No colorectal cancer was negative. Among lung adenocarcinomas, 68% were positive with B18 and 50% were negative with the CEA-specific antibody D14. The small number of mesotheliomas tested were all negative for CEA. The article does not say where in the body they arose and does not study asbestos. Of the four monoclonal antibodies, only B18 stained hepatocellular carcinomas (12 of 22); the polyclonal antibody stained 50% of those it was tested on. The authors concluded that CEA staining can be an additional tool for identifying a tumor's origin, enhanced in most instances by combining monoclonal antibodies, and that CEA antibodies are most useful when negative in gland-forming tumors of unknown origin.

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: Immunohistochemical (tissue staining) survey of archived surgical pathology specimens
• Who was studied: 303 primary and metastatic carcinomas from many sites (including 36 lung, 22 liver, 42 breast and 56 colon), plus 7 melanomas, 3 mesotheliomas and 7 carcinoid tumors, from pathology files in Boston and Dublin. Dates are not given.
• Exposure: No asbestos or occupational exposure was studied. Tumor sections were stained with four monoclonal CEA antibodies: D14 and B7.1, which are specific for CEA, and B18 and B7.8, which also detect related proteins. 110 tumors were also stained with a polyclonal anti-CEA antibody (DAKO).
• Main results:
  • No colorectal carcinoma (56 tested) stained negative with the monoclonal antibodies.
  • In lung adenocarcinomas (22 tested), B18 was positive in 68% and the CEA-specific D14 was negative in 50%.
  • All 3 mesotheliomas tested were negative for CEA.
  • 12 of 22 (55%) hepatocellular carcinomas were positive with the monoclonal antibody B18, with staining confined to canalicular structures. The other three monoclonal antibodies were negative in all cases.
  • 50% of the hepatocellular carcinomas tested with the DAKO polyclonal antibody were positive.
  • Only 4 of 42 (10%) breast carcinomas and none of 22 prostatic carcinomas were positive with the CEA-specific antibody D14.
  • In prostatic carcinomas, the CEA-specific antibodies were negative in all 22, and 4 of 22 stained focally with B18.
  • In the 74 metastatic carcinomas, the authors found no differences in CEA expression compared with primary tumors.
  • The authors judged that for gland-forming tumors of undetermined primary site, CEA antibodies are most useful when negative.
• The authors' conclusion: The authors concluded that CEA staining can be an adjunct in identifying the origin of common epithelial cancers, and that this use is enhanced in most instances by a simple combination of monoclonal antibodies.
• Limitations the authors state:
  • Only a limited number of metastatic cases were examined.
  • Only a small number of mesotheliomas were tested.
  • No medullary thyroid carcinomas were included.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoembryonic Antigen (CEA), Monoclonal, Pathology, Neoplasm, Glycoprotein, Adenocarcinoma, Carcinoma, Serous Papillary Carcinoma.

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• Keratin proteins and carcinoembryonic antigen in lung carcinoma: an immunoperoxidase study of fifty-four cases, with ultrastructural correlations — J.W. Said, G. Nash, et al. (1983)

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