Practical utility of insulin-like growth factor II mRNA-binding protein 3, glucose transporter 1, and epithelial membrane antigen for distinguishing malignant mesotheliomas from benign mesothelial proliferations

Our plain-English summary of Practical utility of insulin-like growth factor II mRNA-binding protein 3, glucose transporter 1, and epithelial membrane antigen for distinguishing malignant mesotheliomas from benign mesothelial proliferations, by S. Chang, M.H. Oh, S.Y. Ji, et al (Pathology International, 2014).

The study

• Authors: S. Chang, M.H. Oh, S.Y. Ji, J. Han, T.J. Kim, M. Eom, K.Y. Kwon, S.Y. Ha, Y.D. Choi, C.H. Lee, Y. Lee, S.H. Jung
• Journal: Pathology International
• Published: 2014;64(12):607-12
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The differentiation of malignant mesotheliomas and benign mesothelial proliferations is crucial in determining patient care and prognosis. But, this distinction can be extremely difficult, particularly in small biopsies. Recently, insulin-like growth factor II mRNA-binding protein 3 (IMP3) and glucose transporter 1 (GLUT-1) have been reported as specific and sensitive markers in the distinction of mesotheliomas from benign mesothelial proliferations. The purpose of this study is to evaluate the utility of IMP3, GLUT-1, and epithelial membrane antigen (EMA) immunohistochemistry for distinguishing mesotheliomas from benign mesothelial proliferations. Immunoexpression of IMP3, GLUT-1, and EMA was evaluated in 88 malignant mesotheliomas, 35 adenomatoid tumors, and 20 benign lung tissues with reactive mesothelial cells. The sensitivity for IMP3, GLUT-1, and EMA was 37%, 21%, and 41%, respectively. The specificity for IMP3, GLUT-1, and EMA was 100%. When IMP3, GLUT1, and EMA combined, the sensitivity was 66% for IMP3/EMA staining, 53% for GLUT-1/EMA staining, and 45% for IMP3/GLUT-1. Use of IMP3 and EMA together is more helpful to distinguish malignant mesotheliomas from benign mesothelial proliferations than the use of IMP3 or EMA alone.

© 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

In plain English

This Korean laboratory study tested whether three tissue stains (IMP3, GLUT-1 and EMA) could help pathologists tell malignant mesothelioma apart from benign growths of mesothelial cells. The authors stained 88 malignant mesotheliomas (47 pleural, 41 peritoneal) from the archive of the Korea Malignant Mesothelioma Surveillance System, 2002 to 2012. They compared them with 35 adenomatoid tumors and 20 benign lung tissues with reactive mesothelial cells. The study did not look at asbestos exposure. IMP3 stained positive in 32 of 87 mesotheliomas (37%), GLUT-1 in 18 of 87 (21%) and EMA in 36 of 88 (41%). None of the benign cases stained positive for any of the three. When a mesothelioma counted as positive if either IMP3 or EMA stained, 58 of 88 (66%) were detected. That was significantly more than the GLUT-1/EMA pair (53%) or the IMP3/GLUT-1 pair (45%). The authors recommended the IMP3/EMA pair. They cautioned that each marker alone had low sensitivity, that negative staining should not be considered informative, and that correlation with clinical, radiological and microscopic findings is most important.

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 (immunohistochemistry) comparing staining of malignant mesotheliomas with benign mesothelial proliferations
• Who was studied: 88 malignant mesothelioma tissue samples (47 pleural, 41 peritoneal; 60 epithelioid, 11 sarcomatoid, 17 biphasic) from the archive of the Korea Malignant Mesothelioma Surveillance System, 2002 to 2012. The comparison group was 35 adenomatoid tumors and 20 benign lung tissues with reactive mesothelial cells.
• Exposure: Not studied. The study examined laboratory staining markers (IMP3, GLUT-1, EMA), not asbestos or any other exposure.
• Main results:
  • Among malignant mesotheliomas, IMP3 was positive in 32 of 87 (37%)
  • Among malignant mesotheliomas, GLUT-1 was positive in 18 of 87 (21%)
  • Among malignant mesotheliomas, EMA was positive in 36 of 88 (41%)
  • None of the 20 reactive mesothelial lesions or 35 adenomatoid tumors stained for any of the three markers (specificity 100%)
  • 58 of 88 malignant mesotheliomas (66%) were positive for IMP3 or EMA
  • 47 of 88 malignant mesotheliomas (53%) were positive for GLUT-1 or EMA, and 39 of 87 (45%) for IMP3 or GLUT-1
  • The sensitivity of the IMP3/EMA pair was significantly higher than IMP3/GLUT-1 (P = 0.0062) or GLUT-1/EMA (P = 0.0001)
  • No significant difference in marker expression between epithelioid and sarcomatoid mesotheliomas
• The authors' conclusion: The authors recommended using IMP3 and EMA together to distinguish malignant mesotheliomas from benign mesothelial proliferations. They added that correlation with clinical, radiological and microscopic findings is most important.
• Limitations the authors state:
  • Each marker alone was unsuitable because of low sensitivity
  • Negative staining should not be considered informative
  • GLUT-1 also stained red blood cells, endothelial cells and necrotic areas, and often stained tumor patchily. This could lead to false positive or false negative results, especially in biopsies.
  • Other newer markers (CD146, CD147, p16) were not included

Topics

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

Medical terms in this study, explained in our Lexicon: Epithelial Membrane Antigen (EMA), Malignant Mesothelioma, Prognosis, Mesothelioma, Immunohistochemistry, Adenomatoid Tumor, Reactive Mesothelial Cells, GLUT1.

Related studies

• IMP3 and GLUT-1 immunohistochemistry for distinguishing benign from malignant mesothelial proliferations — A.F. Lee, A.M. Gown, et al. (2013)
• Insulin-like growth factor II messenger RNA-binding protein 3 expression in gastrointestinal mesenchymal tumors — H. Yamamoto, K. Arakaki, et al. (2014)
• Utility of glucose transporter 1 in the distinction of benign and malignant thoracic and abdominal mesothelial lesions — S.M. Lagana, R.N. Taub, et al. (2012)
• Diagnostic value of BRCA1-associated protein-1, glucose transporter-1 and desmin expression in the discrimination between reactive mesothelial proliferation and malignant mesothelioma in tissues and effusions — S. Önder, E. Özogul, et al. (2019)
• CD146 and insulin-like growth factor 2 mRNA-binding protein 3 predict prognosis of asbestos-induced rat mesothelioma — Y. Okazaki, H. Nagai, et al. (2013)
• Insulin-Like Growth Factor 2 mRNA Binding Protein 3 Promotes Cell Proliferation of Malignant Mesothelioma Cells by Downregulating p27Kip1 — I. Endo, V.J. Amatya, et al. (2021)

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