MOC31 for the Diagnosis of Metastatic Carcinoma and Mesothelial Lesions in Effusion Fluid-A Systematic Review and Meta-Analysis

Our plain-English summary of MOC31 for the Diagnosis of Metastatic Carcinoma and Mesothelial Lesions in Effusion Fluid-A Systematic Review and Meta-Analysis, by A.H. Lin, M. Hsu, J.K.M. Ng, et al (Diagnostics, 2025).

The study

• Authors: A.H. Lin, M. Hsu, J.K.M. Ng, S.J. Farahani, R. Meçani, J. Nano, J.J.X. Li, P. Vielh, T. Muka
• Journal: Diagnostics
• Published: 2025;15(21)
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/Objectives: MOC31 immunostain identifies carcinoma cells and is often used in effusion fluid cytology. This systematic review and meta-analysis aim to detail the diagnostic performance of MOC31 with subgroup analysis for different types of carcinomas. Methods: A literature search from five databases was performed. Relevant studies were reviewed for the calculation of pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve of hierarchical summary receiver operating characteristics (AUC-HSROC). Risk of bias, heterogeneity, and publication bias were assessed by the QUADAS-2, I2 index, and Deeks' funnel plot. Results: In total, 25 studies (10 retrospective cohorts, 10 case-control studies, and 5 case series) were included. The pooled sensitivity, specificity, NLR, PLR, and DOR were 0.926 (0.827-0.971), 0.932 (0.883-0.961), 0.079 (0.005-0.152), 13.610 (5.327-21.892), and 172.475 (83.150-428.100), respectively. The AUC-HSROC was 0.975, indicating excellent performance. Further analysis for adenocarcinomas, mesotheliomas, and benign/reactive mesothelial cells showed sensitivity for adenocarcinomas at 0.962 (0.948-0.975) and specificity for mesotheliomas and mesothelial cells at 0.934 (0.900-0.967) and 0.997 (0.994-1.000). Sensitivity in all four primary site subgroups (female genital, gastrointestinal/hepatobiliary, lung and breast) of adenocarcinoma were high (>0.910). Heterogeneity was observed, and meta-regression identified a trend for the year of publication. No evidence of publication bias was observed. Conclusions: Evidence shows that MOC31 could be a robust immunocytochemical marker for identifying and excluding metastatic carcinoma, with excellent diagnostic performance across types of adenocarcinomas. However, evidence is mainly from retrospective studies, highlighting the need for high-quality evidence to further establish MOC31diagnostic utility.

In plain English

This article was a systematic review and meta-analysis, not a new study of patients. The authors searched five databases up to 29 July 2024 for studies of MOC31, a laboratory stain used on fluid from body cavities to tell metastatic carcinoma (cancer spread from elsewhere) apart from mesothelioma and from benign or reactive mesothelial cells. They pooled 25 studies covering 3009 specimens: 1947 metastatic carcinomas and 1062 mesothelioma or benign/reactive effusions. The article did not study asbestos exposure. Across all studies, the pooled sensitivity (the share of carcinomas MOC31 picked up) was 0.926 (95% CI 0.827 to 0.971), and the pooled specificity (the share of non-carcinoma specimens it correctly called negative) was 0.932 (0.883 to 0.961). In the main text, specificity was 0.912 (0.864 to 0.960) for mesothelioma specimens and 0.996 (0.991 to 1.000) for benign or reactive mesothelial cells. The article's abstract gives different figures for these two groups. Results varied considerably between studies. The authors concluded that MOC31 is a robust marker for metastatic carcinoma. They noted that nearly half the studies lacked blinding, 40% used non-consecutive case selection, and studies defined a positive stain in different ways.

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: Systematic review and meta-analysis of diagnostic accuracy studies (10 retrospective cohorts, 10 case-control studies, 5 case series)
• Who was studied: 25 published studies (1991 to 2023; most from the USA, then China, the Netherlands, Greece and India) totalling 3009 effusion fluid specimens: 1947 metastatic carcinomas and 1062 mesothelioma or benign/reactive effusions; literature searched up to 29 July 2024
• Exposure: No asbestos or fiber exposure was studied. The test evaluated was MOC31 immunostaining of effusion fluid cytology specimens, compared against histology and/or clinical follow-up.
• Main results:
  • Overall pooled sensitivity of MOC31 for metastatic carcinoma across all 25 studies was 0.926 (95% CI 0.827 to 0.971)
  • Overall pooled specificity was 0.932 (95% CI 0.883 to 0.961)
  • Overall negative likelihood ratio 0.079 (95% CI 0.005 to 0.152), positive likelihood ratio 13.610 (5.327 to 21.892), diagnostic odds ratio 172.475 (83.150 to 428.100); area under the HSROC curve 0.975
  • Retrospective cohort subgroup: sensitivity 0.909 (95% CI 0.732 to 0.973) and specificity 0.954 (0.832 to 0.989)
  • Adenocarcinoma specimens: sensitivity 0.995 (95% CI 0.991 to 0.998) in the fixed-effects model and 0.962 (0.948 to 0.975) in the random-effects model
  • Specificity was 0.912 (95% CI 0.864 to 0.960) for mesothelioma specimens and 0.996 (0.991 to 1.000) for benign or reactive mesothelial cells (main text figures; the abstract states 0.934 and 0.997)
  • Among 1265 metastatic adenocarcinomas with a known primary site, sensitivity was 0.983 for female genital primaries, 0.958 for gastrointestinal/hepatobiliary, 0.944 for lung and 0.917 for breast
  • Heterogeneity between studies was high for sensitivity (I2 = 74.9%) and moderate for specificity (I2 = 54.4%). In meta-regression only year of publication showed a trend (p = 0.094).
  • Deeks' test did not indicate publication bias (p = 0.684)
• The authors' conclusion: The authors concluded that MOC31 is a robust marker for identifying metastatic carcinoma in effusion fluid. In their view, unless lymphomas, sarcomas, melanomas or rare carcinomas are suspected, it should be adequate for diagnosing and excluding most common metastatic carcinomas. They called for uniform definitions of a positive result in future studies.
• Limitations the authors state:
  • Nearly half the included studies (48%) lacked blinding between the test and the reference diagnosis, which may have overestimated accuracy
  • 40% of studies used non-consecutive or selective case inclusion, risking spectrum bias
  • Studies defined and interpreted MOC31 positivity differently, a potential threshold effect
  • High statistical heterogeneity across pooled estimates requires careful interpretation
  • The review could not assess MOC31 performance in uncommon carcinomas
  • Evidence comes mainly from retrospective studies

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Systematic Review, Meta-Analysis, Fluid Cytology, Odds Ratio, Adenocarcinoma, Mesothelioma, Reactive Mesothelial Hyperplasia.

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