How useful is GLUT-1 in differentiating mesothelial hyperplasia and fibrosing pleuritis from epithelioid and sarcomatoid mesotheliomas? An international collaborative study

Our plain-English summary of How useful is GLUT-1 in differentiating mesothelial hyperplasia and fibrosing pleuritis from epithelioid and sarcomatoid mesotheliomas? An international collaborative study, by A.N. Husain, M.K. Mirza, A. Gibbs, et al (Lung Cancer, 2014).

The study

• Authors: A.N. Husain, M.K. Mirza, A. Gibbs, K. Hiroshima, Y. Chi, R. Boumendjel, N. Stang, T. Krausz, F. Galateau-Salle
• Journal: Lung Cancer
• Published: 2014;83(3):324-8
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Mesothelial hyperplasia (MH) and fibrosing pleuritis (FP) can be difficult to distinguish from epithelioid (MM-E) and sarcomatoid (MM-S) malignant pleural mesotheliomas. GLUT-1 has shown variable results regarding its sensitivity and specificity when used to evaluate mesothelial proliferations. We evaluated the utility of GLUT-1 immunostaining in differentiating MH and FP from MM-E and MM-S.

Materials And Methods: In this retrospective study, diagnostically well-characterized cases (MH=31, FP=29, MM-E=41, MM-S=29) were collected and manually stained for GLUT-1. All slides were visually scored by 2 pathologists; using the following system: 0%, 1+ 1-25%, 2+ 26-50% and 3+ >51% cells staining.

Results: All benign cases (n=60) were negative for GLUT-1 while 45 of 78 (58%) MM [21 of 41 (50%) MM-E, 21 of 29 (72%) MM-S and 3 of 3 biphasic mesothelioma (100%)] had 1+ to 3+ staining. Of the MM-E, 10 had 1+, and 11 had 2+ staining; of the MM-S 3 had 1+, 15 had 2+ and 3 had 3+ staining. Both sarcomatoid and epithelioid components of the 3 biphasic mesotheliomas revealed 1+ staining. All 5 desmoplastic MM were negative.

Conclusions: Positive staining with GLUT-1 is helpful since it is present in half of MM-E and three-quarter of MM-S. Although all reactive mesothelial lesions were negative, the absence of immunoreactivity does not exclude the diagnosis of MM. As with all IHC stains used for diagnostic purposes, GLUT-1 has to be a part of a panel, and the results interpreted in the context of clinical, radiological and histological findings.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective laboratory study, using tissue contributed by members of an international mesothelioma panel, asked whether staining for a protein called GLUT-1 helps tell two benign pleural conditions (mesothelial hyperplasia and fibrosing pleuritis) apart from malignant pleural mesothelioma. Two pathologists at one institution scored the stained slides without knowing the original diagnoses. None of the 60 benign cases stained positive. Of 78 mesotheliomas, 45 (58%) did: 21 of 29 (72%) sarcomatoid, 21 of 41 (50%) epithelioid, 3 of 3 biphasic and 0 of 5 desmoplastic. The authors reported an overall sensitivity of 58% and a specificity of 100%. Most positive cases had staining in no more than half of the cells. In 26 of 78 cases (33%), staining favored tumor cells next to areas of dead tissue (necrosis). The authors concluded that positive staining supports a diagnosis of mesothelioma but a negative stain does not rule it out. They said GLUT-1 should be part of a panel of tests, interpreted with clinical, imaging and tissue findings, and that its usefulness is restricted in small biopsies. The study did not examine 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: retrospective immunohistochemistry (tissue staining) study of diagnostic accuracy, with blinded scoring
• Who was studied: Pleural tissue samples contributed by members of the international mesothelioma panel: 60 benign cases (31 mesothelial hyperplasia, 29 fibrosing pleuritis) and 78 malignant mesotheliomas (41 epithelioid, 29 sarcomatoid, 3 biphasic, 5 desmoplastic). Dates and patient details are not given.
• Exposure: No asbestos or fiber exposure was studied. The variable examined was GLUT-1 immunostaining of tissue sections, scored by two blinded pathologists as 1+ (1 to 25% of cells), 2+ (26 to 50%) or 3+ (51% or more).
• Main results:
  • GLUT-1 staining was positive in 45 of 78 malignant mesotheliomas (58%) and in none of the 60 reactive (benign) pleural proliferations.
  • By subtype, staining was positive in 21/29 (72%) sarcomatoid and 21/41 (50%) epithelioid mesotheliomas, as the article prints them.
  • All 3 biphasic mesotheliomas were positive (both components 1+). All 5 desmoplastic mesotheliomas were negative (0/5).
  • Overall sensitivity was 58% and specificity was 100%.
  • Most positive cases scored 1+ or 2+. Only 3 sarcomatoid cases scored 3+.
  • In 26 of 78 mesotheliomas (33%), staining favored tumor cells next to necrosis, and it was not related to blood vessels.
  • Among the architectural patterns of epithelioid mesothelioma, there was no significant difference in staining.
• The authors' conclusion: The authors concluded that positive GLUT-1 staining is helpful in supporting malignant mesothelioma, but a negative result does not exclude it. They said GLUT-1 must be used as part of a panel and interpreted with clinical, radiological and histological findings.
• Limitations the authors state:
  • Because the percentage of staining tumor cells varied considerably, GLUT-1 is of restricted use in small biopsies with little tumor.
  • Weak non-specific staining of dense collagenous tissue and plasma cells can be mistaken for positive staining.

Topics

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

Medical terms in this study, explained in our Lexicon: Reactive Mesothelial Hyperplasia, Epithelioid, Sarcomatoid, Mesothelioma, Pleural Mesothelioma, Biphasic Mesothelioma, Desmoplastic Mesothelioma.

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