The value of anticarcinoembryonic antigen, human milk factor globulin, and antikeratin antibodies in differentiating mesothelioma from lung carcinoma

Our plain-English summary of The value of anticarcinoembryonic antigen, human milk factor globulin, and antikeratin antibodies in differentiating mesothelioma from lung carcinoma, by V.M. Joglekar, D. Oliver, M. Harris (British Journal of Industrial Medicine, 1991).

The study

• Authors: V.M. Joglekar, D. Oliver, M. Harris
• Journal: British Journal of Industrial Medicine
• Published: 1991;48(1):34-7
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Monoclonal anticarcinoembryonic antigen (antiCEA), human milk factor globulin (HMFG2), and antikeratin antibodies were assessed for their value in the differential diagnosis of pleural mesothelioma (53 cases) and carcinoma of the lung (60 cases) in material from necropsies. In 40 of the cases pleural biopsies were also studied in the same manner. AntiCEA was found to be the best discriminating antibody for most types of mesothelioma; HMFG2 was slightly less valuable but a useful additional tool. Antikeratin was the least useful. For both antiCEA and HMFG2 antibodies, however, the proportion of carcinomas staining was smaller than in previous studies and this, combined with the positive staining of some mesotheliomas, reduces the value of the reactions in the individual case. Medical panels adjudicating compensation claims should not use these reactions as the sole criteria in deciding the origin of the tumours in these cases.

In plain English

This study tested whether three laboratory stains (the antibodies antiCEA, HMFG2 and antikeratin AE1/AE3) could help pathologists tell pleural mesothelioma apart from lung carcinoma involving the pleura. The authors used postmortem tissue from 53 mesothelioma and 60 lung carcinoma cases diagnosed between 1979 and 1987 at North Lonsdale Hospital, and pleural biopsies from 40 of these patients. Two authors read the slides blindly. In postmortem tissue, antiCEA was negative in 51 of 53 mesotheliomas but also in 38 of 60 carcinomas. HMFG2 was negative in 43 of 53 mesotheliomas, and about half of carcinomas were also negative. Antikeratin was positive in 40 of 53 mesotheliomas and 40 of 60 carcinomas. Biopsy and postmortem results fully agreed in 26 of 40 cases, and every disagreement was a negative biopsy with a positive postmortem result. The authors concluded that antiCEA was the most useful antibody and HMFG2 a useful second one. Because many carcinomas did not stain and some mesotheliomas did, the authors said medical panels should not use these stains as the sole criteria in mesothelioma compensation claims.

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 laboratory (immunohistochemical) study of archived postmortem and pleural biopsy tissue, comparing antibody staining between two tumour types
• Who was studied: 113 postmortem cases (53 pleural mesothelioma, 60 lung carcinoma) diagnosed 1979 to 1987, from the postmortem files of the Department of Pathology, North Lonsdale Hospital (Barrow-in-Furness); pleural biopsy material from 40 of these cases was also analysed
• Exposure: Not an asbestos exposure study. What was tested was staining of tumour tissue with three antibodies: monoclonal antiCEA, HMFG2 and antikeratin (AE1/AE3).
• Main results:
  • Postmortem tissue, antiCEA: negative in 51 of 53 mesotheliomas (96.2%). The authors called it by far the most useful antibody.
  • Postmortem tissue, antiCEA: also negative in 38 of 60 lung carcinomas (63.3%), a higher percentage of negative carcinomas than in previous reports
  • Postmortem tissue, HMFG2: negative in 43 of 53 mesotheliomas; the authors state that 52% of carcinomas were also negative (Table 1: 31 of 60)
  • Postmortem tissue, antikeratin: positive in 40 of 53 mesotheliomas (75.5%) and 40 of 60 carcinomas (66.7%). The authors found it not useful for telling the two apart.
  • Pleural biopsy tissue (Table 2), mesotheliomas (26): antikeratin positive in 17, HMFG2 positive in 6, antiCEA positive in 4
  • Pleural biopsy tissue (Table 2), carcinomas (14): antikeratin positive in 11, HMFG2 positive in 6, antiCEA positive in 5
  • Biopsy and postmortem results agreed completely for all three antibodies in 26 of 40 cases (65%; 15 mesotheliomas, 11 carcinomas)
  • In every one of the 14 discrepant cases, the biopsy reaction was negative and the postmortem reaction positive. The authors suggested a sampling problem in the biopsy.
• The authors' conclusion: The authors concluded that antiCEA and HMFG2 are useful for distinguishing mesothelioma from carcinoma. They also said the low proportion of staining carcinomas, together with some mesotheliomas staining positive, reduces their value in the individual case. In their view, medical panels should not use these stains as the sole criteria for mesothelioma compensation claims.
• Limitations the authors state:
  • Many pleural biopsies had too few tumour cells: 20 of the original 60 had to be excluded
  • Normal alveolar lining cells stain positively for HMFG2, so care is needed to evaluate only tumour cells in biopsies

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Carcinoma, Monoclonal, Differential Diagnosis, Pleural Mesothelioma.

Related studies

• Immunocytological staining reactions of anti-carcinoembryonic antigen, Ca, and anti-human milk fat globule monoclonal antibodies on benign and malignant exfoliated mesothelial cells — A.K. Ghosh, E.B. Butler (1987)
• Use of antibodies to carcinoembryonic antigen and human milk fat globule to distinguish carcinoma, mesothelioma, and reactive mesothelium — R.J. Marshall, A. Herbert, et al. (1984)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Immunohistological staining of reactive mesothelium, mesothelioma, and lung carcinoma with a panel of monoclonal antibodies — A.K. Ghosh, K.C. Gatter, et al. (1987)
• CD24 is highly useful in differentiating high-grade serous carcinoma from benign and malignant mesothelial cells — B. Davidson (2016)
• Immunohistochemical analysis still has a limited role in the diagnosis of malignant mesothelioma. A study of thirteen antibodies — F. Roberts, C.M. Harper, et al. (2001)

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