Immunocytochemical staining of serous effusions with the monoclonal antibody Ber-EP4

Our plain-English summary of Immunocytochemical staining of serous effusions with the monoclonal antibody Ber-EP4, by M. De Angelis, I.D. Buley, A. Heryet, et al (Cytopathology, 1992).

The study

• Authors: M. De Angelis, I.D. Buley, A. Heryet, W. Gray
• Journal: Cytopathology
• Published: 1992;3(2):111-7
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Cytospin preparations were made from 102 serous effusions for immunocytochemical staining using a panel of monoclonal antibodies including a new monoclonal antibody Ber-EP4. On cytological examination, 32 fluids were reported to contain tumour cells consistent with metastatic adenocarcinoma; 66 contained benign cells only and three were reported to contain cells suspicious of malignancy. One effusion contained tumour cells consistent with malignant mesothelioma. Positive staining of the tumour cells with Ber-EP4 was observed in the 32 effusions (100%) which contained adenocarcinoma cells. No staining of the mesothelial cells in these 32 specimens was observed. Carcinoembryonic antigen, epithelial membrane antigen Ca2 and CD15 staining of tumour cells was noted in 53%, 50%, 50% and 9% of these cases, respectively. None of the mesothelial cells in the benign effusions stained with Ber-EP4. Nor did the malignant mesothelial cells in the only case of malignant mesothelioma. These findings suggest that Ber-EP4 is a valuable addition to antibodies available for the differential diagnosis of mesothelial cells and adenocarcinoma cells in serous effusions.

In plain English

This laboratory study, by researchers in Oxford, England, and Naples, Italy, tested whether a new antibody stain called Ber-EP4 could help tell cancer cells apart from mesothelial cells (the cells lining the chest and abdomen) in fluid collected from around the lungs and abdomen. The authors stained 102 pleural and peritoneal fluid samples with Ber-EP4 and other antibody stains. On microscope examination, 32 samples contained metastatic adenocarcinoma cells, 66 were benign, three were suspicious of cancer, and one contained mesothelioma. Ber-EP4 stained the adenocarcinoma cells in all 32 cancer samples. It did not stain mesothelial cells in the benign samples or in the single mesothelioma. By comparison, the CEA stain was positive in 53% of cancer samples and the CD15 stain in 9%. One of the three suspicious samples stained with Ber-EP4. That patient later had a confirmed recurrence of a previously removed colon cancer. The authors concluded that Ber-EP4 was a valuable addition to antibody panels. Because experience with it was limited and rare false results were possible, they said cell appearance and several antibodies should still be used. Asbestos exposure was not studied.

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 comparing antibody (immunocytochemical) staining patterns on a routine series of fluid samples
• Who was studied: 102 pleural and peritoneal fluid samples: 73 sent to the John Radcliffe Hospital, Oxford, and 29 to the Cancer Institute, Naples. 32 contained metastatic adenocarcinoma, with the primary site known in 21 (nine ovary, seven breast, two gastrointestinal tract, three lung). 66 were reactive benign effusions, three were suspicious of malignancy, and one was a mesothelioma. Dates of collection were not given.
• Exposure: No asbestos or fiber exposure was studied. The test examined was a panel of six monoclonal antibodies: Ber-EP4, LP34/Cam 5.2 (cytokeratin), E29 (epithelial membrane antigen), Ca2, A5B7 (carcinoembryonic antigen) and BY87A (CD15).
• Main results:
  • Ber-EP4 stained the adenocarcinoma cells in all 32 fluids containing metastatic adenocarcinoma.
  • Ber-EP4 did not stain reactive mesothelial cells, and it did not stain the single mesothelioma.
  • The CEA antibody was positive in 53% of the secondary (metastatic) carcinoma cases. The authors suggested this may relate to the high proportion of breast cancers in the series.
  • The CD15 antibody BY87A was positive in 9% of cases, with no staining of mesothelial cells.
  • Ca2 stained mesothelial cells in 44% of reactive (benign) effusions and stained 50% of effusions containing metastatic carcinoma cells.
  • Epithelial membrane antigen staining was seen in 12% of benign fluids and in 50% of malignant effusions.
  • One of the three samples classed as suspicious of malignancy stained with Ber-EP4. That patient, who had a previously resected colon carcinoma, later had a histologically proven recurrence in the surgical scar.
  • In 18 benign effusions no mesothelial cells could be recognized, and these cases were excluded from Table 3.
• The authors' conclusion: The authors concluded that Ber-EP4 was a valuable addition to antibody panels for distinguishing reactive mesothelial cells from metastatic adenocarcinoma in serous effusions, showing higher sensitivity than CEA. They added that interpretation should still take account of conventional cell appearance and should use panels of antibodies.
• Limitations the authors state:
  • Practical experience with Ber-EP4 on cells in serous fluids was limited, and rare false-positive or false-negative reactions were possible.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Monoclonal Antibody, Ber-EP4, Monoclonal, Adenocarcinoma, Malignant Mesothelioma, Mesothelial Cells, Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen (EMA).

Related studies

• Diagnostic value of monoclonal antibody B72.3 in detecting adenocarcinoma cells in serous effusions — A.F. Lauritzen (1989)
• Quality control of immunocytochemical staining of effusions using a standardized method of cell processing — V. Kuenen-Boumeester, P. van Loenen, et al. (1996)
• The value of anti-calretinin antibody in the differential diagnosis of normal and reactive mesothelia versus metastatic tumors in effusion cytology — H. Nagel, B. Hemmerlein, et al. (1998)
• Utility of HBME-1 immunostaining in serous effusions — V. Ascoli, C. Carnovale-Scalzo, et al. (1997)
• Immunocytochemical utility of claudin-4 versus those of Ber-EP4 and MOC-31 in effusion cytology — T. Oda, S. Ogata, et al. (2016)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)

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