E-cadherin and calretinin: a useful combination of immunochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma

Our plain-English summary of E-cadherin and calretinin: a useful combination of immunochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma, by M.P. Leers, M.M. Aarts, P.H. Theunissen (Histopathology, 1998).

The study

• Authors: M.P. Leers, M.M. Aarts, P.H. Theunissen
• Journal: Histopathology
• Published: 1998;32(3):209-16
• Cited by: 88 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: To assess the diagnostic accuracy of combinations of antibodies in the differential diagnosis of metastatic carcinomas and mesotheliomas in pleural lesions.

Methods And Results: The specificity and sensitivity of the commercially available antibodies Ber-EP4, MOC-31, CEA, B72.3, CD15, E-cadherin and calretinin were evaluated using an indirect immunoperoxidase staining technique. This technique was applied to formalin-fixed, paraffin-embedded tissue blocks of pleural lesions. Twenty-one patients with metastatic carcinoma (MC) and 20 patients with malignant mesothelioma (MM) were included. The combination E-cadherin/calretinin had the highest specificity (MC 100% and MM 91%) and sensitivity (MM 100% and MC 91%) considering both categories of tumours.

Conclusions: The combination of E-cadherin/calretinin appears to be a suitable panel for distinguishing metastatic carcinomas and mesotheliomas in pleural lesions. The additional value of other markers is limited.

In plain English

This study, from the pathology department of De Wever Hospital in Heerlen, the Netherlands, tested how well seven laboratory antibody stains tell malignant mesothelioma apart from cancer that has spread to the pleura from elsewhere (metastatic carcinoma). The authors stained stored pleural biopsy tissue from 20 mesotheliomas, 21 metastatic carcinomas and 7 benign reactive mesothelial samples. Two readers scored the slides without knowing the diagnosis. All 20 mesotheliomas stained for calretinin; one of the 21 carcinomas did. E-cadherin stained 20 of 21 carcinomas and 3 of 20 mesotheliomas. The text reports E-cadherin positive with calretinin negative as 100% specific and 91% sensitive for metastatic carcinoma; the article's own table gives 86% sensitivity. The reverse pattern was 100% specific and 80% sensitive for mesothelioma. Adding a third marker reached at most 86% sensitivity for carcinoma. The authors concluded that E-cadherin plus calretinin appears to be a significant aid in telling the two apart. They noted that only 9 of the 20 mesotheliomas were confirmed by autopsy. The study did not look at 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: Diagnostic accuracy study of immunohistochemical (antibody) stains on stored pleural biopsy tissue, scored blind by two readers
• Who was studied: Formalin-fixed, paraffin-embedded pleural biopsy tissue from 20 malignant mesotheliomas, 21 metastatic carcinomas and 7 benign reactive mesothelial proliferations, Department of Pathology, De Wever Hospital, Heerlen, the Netherlands; study period not stated
• Exposure: No asbestos or other exposure was studied. The tests evaluated were seven antibody stains: B72.3, CEA, Ber-Ep4, MOC-31 and CD15 (adenocarcinoma markers), plus E-cadherin and calretinin
• Main results:
  • All 20 mesotheliomas were positive for calretinin
  • One of the 21 metastatic carcinomas was positive for calretinin
  • 20 of 21 metastatic carcinomas expressed E-cadherin
  • 3 of 20 mesotheliomas showed staining for E-cadherin
  • Among the 20 mesotheliomas, Ber-Ep4 was positive in 7 and MOC-31 in 10
  • E-cadherin positive with calretinin negative was reported in the text as 100% specific and 91% sensitive for metastatic carcinoma (the article's table gives 86% sensitivity)
  • E-cadherin negative with calretinin positive was 100% specific and 80% sensitive for mesothelioma
  • The best three-marker combinations reached at most 86% sensitivity for adenocarcinoma
  • In all 7 reactive (benign) mesothelial samples, the cells stained strongly for calretinin
• The authors' conclusion: The authors concluded that the combination of E-cadherin and calretinin appears to be a significant aid in differentiating malignant mesothelioma from metastatic carcinoma, and that panels of three or more antibodies added no value
• Limitations the authors state:
  • Only 9 of the 20 mesothelioma diagnoses were confirmed by autopsy
  • The clinical criteria used to diagnose mesothelioma in individual cases were not evaluated in detail
  • Staining intensity was not assessed because of possible variation in staining procedures; only positive versus negative was recorded
  • One metastatic carcinoma case did not meet the study's diagnostic criteria

Topics

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

Medical terms in this study, explained in our Lexicon: Calretinin, Mesothelioma, Adenocarcinoma, Differential Diagnosis, Carcinoma, Ber-EP4, MOC-31, B72.3 (TAG-72).

Related studies

• E-cadherin, E-selectin and vascular cell adhesion molecule: immunohistochemical markers for differentiation between mesothelioma and metastatic pulmonary adenocarcinoma? — A.M. Müller, A. Weichert, et al. (2002)
• Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma — C.E. Comin, L. Novelli, et al. (2001)
• The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology — T.S. Hyun, M. Barnes, et al. (2012)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• The calcium binding protein calretinin is a selective marker for malignant pleural mesotheliomas of the epithelial type — V. Gotzos, P. Vogt, et al. (1996)
• Expression of calretinin by breast carcinoma and the potential for misdiagnosis of mesothelioma — G. Powell, H. Roche, et al. (2011)

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