Carella R, Deleonardi G, D'Errico A, Salerno A, Egarter-Vigl E, Seebacher C, Donazzan G, Grigioni W F
Felice Addarii Institute, Department of Oncology and Hematology, University School of Medicine, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Bologna, Italy.
Am J Surg Pathol. 2001 Jan;25(1):43-50. doi: 10.1097/00000478-200101000-00004.
Immunohistochemistry provides an important indicator for differential diagnosis between pleural malignant mesothelioma and lung adenocarcinoma, which have complex therapeutic and medicolegal implications. To pinpoint a reliable, restricted panel of markers, the authors evaluated the efficacy of select commercial antibodies in a series of patients with confirmed clinicopathologic diagnosis of mesothelioma or lung adenocarcinoma with the aid of multiple logistic classification tables. Specimens of 46 mesotheliomas and 20 lung adenocarcinomas were examined with calretinin, thrombomodulin, cytokeratins (CKs) 5/6, and high-molecular weight CKs (indicators of mesothelioma), alongside MOC 31, Ber-EP4, and carcinoembryonic antigen (CEA; indicators of lung adenocarcinoma). Of the mesotheliomas, 40 of 46 (87%) were positive with calretinin, 29 of 46 (63%) with thrombomodulin, 40 of 46 (87%) with CKs 5/6, and 41 of 46 (89%) with high-weight CKs; five of 46 mesotheliomas (11%) were focally reactive with MOC 31, four of 46 (9%) with Ber-EP4, and two of 46 (4%) with CEA. Of the lung adenocarcinomas, 18 of 20 (90%) were positive with MOC 31, 20 of 20 (100%) with Ber-EP4, and 17 of 20 (85%) with CEA; and two of 20 (10%) were focally reactive with calretinin, one of 20 (5%) with thrombomodulin, none of 20 (0%) with CKs 5/6, and five of 20 (25%) with high-weight CKs. Multiple logistic modeling indicated two batteries of three antibodies permitting more than 98% overall accuracy: Ber-EP4 plus CKs 5/6 plus calretinin, and Ber-EP4 plus CKs 5/6 plus CEA.
免疫组织化学为胸膜恶性间皮瘤和肺腺癌的鉴别诊断提供了一项重要指标，这两种疾病在治疗和法医学方面具有复杂的意义。为了确定一组可靠且有限的标志物，作者借助多重逻辑分类表，评估了一系列经临床病理确诊为间皮瘤或肺腺癌的患者中所选商用抗体的效能。对46例间皮瘤和20例肺腺癌标本进行了钙视网膜蛋白、血栓调节蛋白、细胞角蛋白（CK）5/6和高分子量CK（间皮瘤标志物）检测，同时检测了MOC 31、Ber-EP4和癌胚抗原（CEA；肺腺癌标志物）。在间皮瘤中，46例中有40例（87%）钙视网膜蛋白呈阳性，46例中有29例（63%）血栓调节蛋白呈阳性，46例中有40例（87%）CK 5/6呈阳性，46例中有41例（89%）高分子量CK呈阳性；46例间皮瘤中有5例（11%）对MOC 31呈局灶性反应，46例中有4例（9%）对Ber-EP4呈局灶性反应，46例中有2例（4%）对CEA呈局灶性反应。在肺腺癌中，20例中有18例（90%）MOC 31呈阳性，20例中有20例（100%）Ber-EP4呈阳性，20例中有17例（85%）CEA呈阳性；20例中有2例（10%）对钙视网膜蛋白呈局灶性反应，20例中有1例（5%）对血栓调节蛋白呈局灶性反应，20例中无1例（0%）CK 5/6呈阳性，20例中有5例（25%）高分子量CK呈阳性。多重逻辑模型显示，两组由三种抗体组成的组合总体准确率超过98%：Ber-EP4加CK 5/6加钙视网膜蛋白，以及Ber-EP4加CK 5/6加CEA。
