E-cadherin and cytokeratin subtype profiling in effusion cytology

Our plain-English summary of E-cadherin and cytokeratin subtype profiling in effusion cytology, by J. Han, M.K. Kim, S.J. Nam, et al (Journal of Korean Medical Science, 2004).

The study

• Authors: J. Han, M.K. Kim, S.J. Nam, J.H. Yang
• Journal: Journal of Korean Medical Science
• Published: 2004;19(6):826-33
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diagnostic utility of E-cadherin (E-CD) and cytokeratin (CK) subtype profiling in effusion cytology was investigated, employing immunocytochemistry on cellblock sections available from 211 metastatic carcinomas (MC), 6 mesotheliomas and 73 reactive mesothelial hyperplasias (MH). E-CD and monoclonal carcinoembryonic antigen (mCEA) stained 85% (120/141) and 65% (138/211) of MC, respectively. E-CD staining of MC was frequently heterogeneous (76/120) and absent in all anaplastic carcinomas (0/2). E-CD stained none (0/57) of MH while mCEA and epithelial membrane antigen (EMA) stained 12% (9/73) and 32% (16/32) of MH, respectively. Of 6 mesotheliomas, E-CD focally stained in 2 while mCEA stained none and EMA stained all. CK20 and CK17 stained none of MH or mesotheliomas. CK20 stained 15% of MC and CK 17 stained 22% of MC. CK5/6 and high molecular weight CK stained all mesotheliomas, 56% and 88% of MH, 26% and 39% of MC, respectively. MC showed predominant CK7+/20-expression, with the exceptions of MC from mucinous type of colon/rectum and ovary showing predominant CK20 positive. E-CD may be a useful positive marker for MC in effusion cytology, although it may focally stain in some mesotheliomas. Any positive staining for CK20 of MC suggests MC from the gastrointestinal tract or ovary among others.

In plain English

This laboratory study tested whether staining cells for certain proteins helps tell cancer that has spread from elsewhere (metastatic carcinoma) apart from mesothelial cells in body-cavity fluid (effusions). It did not study asbestos exposure. The authors used fluid cell samples collected at Samsung Seoul Hospital from 1997 to 1999. These came from 211 metastatic carcinomas, 6 mesotheliomas and 73 reactive mesothelial hyperplasias, which are non-cancerous overgrowths of mesothelial cells. The samples were stained for E-cadherin and several cytokeratin types and compared with two other markers, mCEA and EMA. E-cadherin stained 120 of 141 metastatic carcinomas (85%), often unevenly. It stained none of 57 hyperplasias but focally stained 2 of 6 mesotheliomas. CK20 and CK17 stained no hyperplasia or mesothelioma. CK5/6 and high molecular weight cytokeratin stained all 6 mesotheliomas. The authors concluded that E-cadherin may be a useful positive marker for metastatic carcinoma in effusions, but cautioned that it may appear in mesothelioma. They noted that not every case could be tested with every antibody.

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 study: immunostaining of archived effusion cellblock sections, comparing staining patterns across diagnostic groups
• Who was studied: Effusion cellblocks from 211 metastatic carcinomas, 6 mesotheliomas (site not stated) and 73 reactive mesothelial hyperplasias, collected in routine practice at Samsung Seoul Hospital, Korea, 1997 to 1999
• Exposure: No asbestos or other environmental or occupational exposure was studied. The study examined staining with antibodies to E-cadherin, cytokeratins 5/6, 7, 8, 17, 19 and 20, high molecular weight cytokeratin, monoclonal CEA and EMA.
• Main results:
  • E-cadherin stained 120 of 141 metastatic carcinomas (85%)
  • Among the carcinomas that stained for E-cadherin, staining was focal and/or weak with an uneven pattern in 76 of 120 (63%)
  • E-cadherin stained none of the reactive mesothelial hyperplasias (0/57). mCEA stained 12% (9/73) and EMA stained 32% (16/50, per Table 2) of reactive mesothelial hyperplasias.
  • In mesotheliomas, E-cadherin stained 2 of 6 with a focal membranous pattern. mCEA stained none and EMA stained all.
  • mCEA stained 138 of 211 metastatic carcinomas (65%)
  • CK20 stained none of the reactive mesothelial hyperplasias (0/73) or mesotheliomas (0/6), and 31 of 207 metastatic carcinomas (15%). CK17 also stained none of either mesothelial group, and 46 of 207 metastatic carcinomas (22%).
  • CK5/6 and high molecular weight cytokeratin stained 56% and 88% of reactive mesothelial hyperplasias respectively, and all 6 mesotheliomas
  • CK5/6 and high molecular weight cytokeratin stained 26% and 39% of metastatic carcinomas, respectively
  • Metastatic adenocarcinomas from the colon/rectum showed a mainly CK7-negative/CK20-positive pattern. Mesotheliomas and most other adenocarcinoma sites showed a mainly CK7-positive/CK20-negative pattern.
• The authors' conclusion: The authors concluded that E-cadherin, whose staining is often uneven in metastatic carcinoma, may be a useful positive marker for metastatic carcinoma in effusion cytology, but that caution is needed because it may be expressed in mesothelioma.
• Limitations the authors state:
  • Not all cases were stained with all antibodies, because cellblocks were too thin or sections lacked carcinoma cells or failed technically
  • E-cadherin was negative in about 15% of carcinomas, focally positive in some mesotheliomas, and uneven within carcinomas. The authors said these are possible sources of false positive or false negative results.
  • CK5/6 has limits as a positive marker for epithelial mesothelioma: it stained about 25% of adenocarcinomas and did not distinguish mesothelioma from reactive hyperplasia

Topics

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

Medical terms in this study, explained in our Lexicon: Cytology, Carcinoma, Mesothelioma, Reactive Mesothelial Hyperplasia, Monoclonal, Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen (EMA).

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