Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies

Our plain-English summary of Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies, by S.E. Tuttle, J.G. Lucas, D.M. Bucci, et al (Journal of Surgical Oncology, 1990).

The study

• Authors: S.E. Tuttle, J.G. Lucas, D.M. Bucci, J. Schlom, J. Primus
• Journal: Journal of Surgical Oncology
• Published: 1990;45(2):72-8
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A panel of six monoclonal antibodies (MAbs) was employed to evaluate antigen expression in pulmonary adenocarcinomas and mesotheliomas. Monoclonal anti-human milk fat globulin (HMFG-2), anti-carcinoembryonic antigen (NP-2), anti-epithelial membrane antigen (EMA), anti-cytokeratin (PKK-1), anti-tumor-associated antigen 72 (B72.3), and anti-human myelomonocytic antigen (Leu M-1) antibodies were used to localize their respective antigens in formalin-fixed, paraffin-embedded tumors by using the avidin-biotin-complex immunoperoxidase technique. In all, 28 mesotheliomas obtained from Ohio State University Anatomic Pathology files and from a Southwest Oncology Group (SWOG) protocol were compared to 22 pulmonary adenocarcinomas by using this MAb panel. None of the mesotheliomas demonstrated positive staining with MAbs NP-2 (anti-CEA) or Leu M-1. However, 95% (21/22) of adenocarcinomas stained with one of these two antibodies. Although neither of these two MAbs stained all adenocarcinomas, each antibody demonstrated positive immunostaining in more than 90% of the adenocarcinomas studied. Therefore, MABs NP-2 and Leu M-1 are, individually, quite useful for distinguishing mesothelioma from adenocarcinoma. However, in our study, no single MAb could be used to distinguish these two tumor types in every case. MAb B72.3 stained 91% (20/21) adenocarcinomas but also stained 7% (2/28) of mesotheliomas. MAb HMFG-2 reacted positively with 95% of adenocarcinomas, but also stained 39% of the mesotheliomas, usually in a membranous pattern. MAbs EMA and PKK-1 were not found useful in distinguishing mesothelioma from adenocarcinoma. We conclude that MAbs Leu M-1 and NP-2 were both useful in distinguishing mesothelioma from pulmonary adenocarcinoma in that positive staining was demonstrated in adenocarcinomas and not mesotheliomas.

In plain English

This laboratory study tested whether six antibody stains could help pathologists tell malignant mesothelioma from lung adenocarcinoma, two cancers that can look alike. The authors stained stored tissue from 28 mesotheliomas and 22 lung adenocarcinomas. Two stains, NP-2 (which detects carcinoembryonic antigen, CEA) and Leu M-1, stained none of the 28 mesotheliomas. Each stained 20 of 22 adenocarcinomas, and 21 of 22 adenocarcinomas stained with at least one of the two. The stain B72.3 marked 20 of 22 adenocarcinomas but also 2 of 28 mesotheliomas. HMFG-2 marked 95% of adenocarcinomas and 39% of mesotheliomas. EMA and PKK-1 stained most tumors of both types and did not separate them. The authors concluded that NP-2 and Leu M-1 could tell the two cancers apart in most, but not all, cases, and worked better together. They noted that staining was often patchy, so adequate tumor samples were needed. The study did not report on the patients' 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: Laboratory diagnostic (immunohistochemistry) study comparing staining of stored tumor tissue with a panel of six monoclonal antibodies
• Who was studied: Tissue from 28 malignant mesotheliomas (20 epithelioid, 4 mixed epithelioid and sarcomatous, 4 sarcomatous) and 22 pulmonary adenocarcinomas (5 well, 13 moderately, 4 poorly differentiated). Cases came from Ohio State University anatomic pathology files or from institutions entering cases on Southwest Oncology Group protocol #8244. The site of the mesotheliomas (pleural or peritoneal) and the time period are not stated.
• Exposure: Not studied. The article reports no asbestos exposure information for the patients. Asbestos is mentioned only as background in the introduction. What was tested was six antibody stains: B72.3, NP-2 (anti-CEA), Leu M-1, HMFG-2, EMA and PKK-1 (anti-cytokeratin).
• Main results:
  • None of the 28 mesotheliomas stained with NP-2 or Leu M-1. Each of these two stains was positive in more than 90% of the adenocarcinomas (20 of 22 each, per Table II).
  • 21 of 22 adenocarcinomas (95%) stained with NP-2 or Leu M-1. One adenocarcinoma (case A15) was negative for both.
  • B72.3 stained 91% (20 of 22) of adenocarcinomas and 7% (2 of 28) of mesotheliomas.
  • HMFG-2 stained 95% of adenocarcinomas and 39% (11 of 28) of mesotheliomas. In mesotheliomas the staining was mainly in a membranous pattern.
  • EMA stained 95% of adenocarcinomas and 79% of mesotheliomas. PKK-1 stained 95% of adenocarcinomas and 86% of mesotheliomas. Neither stain distinguished the two tumor types.
• The authors' conclusion: The authors concluded that no single antibody separated the two tumors in every case. NP-2 and Leu M-1 could discriminate between mesothelioma and pulmonary adenocarcinoma in most cases, and using them in combination increased diagnostic sensitivity.
• Limitations the authors state:
  • Antigen expression in adenocarcinomas was often patchy, so small biopsy or needle samples may not represent the tumor. This matters because a mesothelioma diagnosis rests partly on negative staining.
  • A false-negative result remains possible. The authors said other studies, such as histochemistry and electron microscopy, should be correlated in equivocal cases.
  • Leu M-1 also stained myelomonocytic cells infiltrating the tumor, and this had to be distinguished from true staining of tumor cells.
  • Comparison with other studies of CEA staining is difficult because different antibodies were used.

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: Malignant Mesothelioma, Adenocarcinoma, Monoclonal, Mesothelioma, Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen (EMA), B72.3 (TAG-72), Pathology.

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• Immunohistochemistry in the distinction between malignant mesothelioma and pulmonary adenocarcinoma: a critical evaluation of new antibodies — A.S. Abutaily, B.J. Addis, et al. (2002)

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