免疫细胞化学在浆液性积液鉴别诊断中的应用：巴氏染色涂片中8种单克隆抗体的比较评估

Immunocytochemistry in the differential diagnosis of serous effusions: a comparative evaluation of eight monoclonal antibodies in Papanicolaou stained smears.

作者信息

Lozano M D, Panizo A, Toledo G R, Sola J J, Pardo-Mindán J

机构信息

Department of Pathology, Clinica Universitaria, University of Navarra, Pamplona, Spain.

出版信息

Cancer. 2001 Feb 25;93(1):68-72.

PMID:11241268

Abstract

BACKGROUND

The distinction between pleural mesothelioma (MS), reactive mesothelium (RM), and adenocarcinoma (AC) in serous effusions continues as a diagnostic problem in pathology. Immunohistochemistry can help, especially in surgical samples, but the optimum panel of antibodies has yet to be reported. The application of these antibodies to serous effusions has displayed variable results. The aim of this study was to evaluate the usefulness of eight monoclonal antibodies in the differential diagnosis of MS, RM, and AC in serous effusions.

METHODS

A total of 44 cytologic specimens of serous effusions (26 pleural, 15 peritoneal, and 3 pericardial) from 30 ACs, 3 MSs, and 11 RMs, previously stained with Papanicolaou stain, were selected retrospectively from our files and stained with HBME-1, thrombomodulin, calretinin, MOC-31, Ber-EP4, E-cadherin, CEA, and CD-15. The immunoreactions were evaluated independently by two pathologists. A stepwise logistic regression analysis was applied to the data to select an appropriate panel of antibodies.

RESULTS

Statistical significance was found with HBME-1, thrombomodulin, MOC-31, Ber-EP4, and CD-15, when comparing both AC versus MS, and AC versus any type of mesothelial proliferation (MS or RM). Using HBME-1, 80% of ACs were negative whereas all three MSs reacted strongly with P = 0.003. A P = 0.02 was reached with thrombomodulin with 76.5% of ACs showing no immunoreactivity. Ber-EP4 and MOC-31 displayed good results with a P < 0.001 and 0.01, respectively. CD-15 reached a P = 0.034. No differences were found using the other antibodies. Ten ACs, all 3 MSs, and 10 RMs were double immunostained with HBME-1 and/or MOC-31 and Ber-EP4 successfully.

CONCLUSIONS

Immunohistochemical studies performed on Papanicolaou stained cytologic smears proved to be useful in the differentiation between metastatic AC and mesothelial proliferation. HBME-1, thrombomodulin, MOC-31, Ber-EP4, and CD-15 were the most useful. In selected cases, it appeared that double immunostaining aided the differential diagnosis. Cancer (Cancer Cytopathol)

摘要

背景

浆液性积液中胸膜间皮瘤（MS）、反应性间皮细胞（RM）和腺癌（AC）的鉴别诊断仍是病理学中的一个难题。免疫组织化学有助于鉴别诊断，尤其是对于手术标本，但尚未见最佳抗体组合的报道。将这些抗体应用于浆液性积液，结果各异。本研究旨在评估8种单克隆抗体在浆液性积液中MS、RM和AC鉴别诊断中的作用。

方法

从我们的存档中回顾性选取44例经巴氏染色的浆液性积液细胞学标本（26例胸膜积液、15例腹膜积液和3例心包积液），这些标本来自30例AC、3例MS和11例RM，用HBME-1、血栓调节蛋白、钙视网膜蛋白、MOC-31、Ber-EP4、E-钙黏蛋白、癌胚抗原（CEA）和CD-15进行染色。由两位病理学家独立评估免疫反应。对数据进行逐步逻辑回归分析，以选择合适的抗体组合。

结果

比较AC与MS以及AC与任何类型的间皮细胞增生（MS或RM）时，发现HBME-1、血栓调节蛋白、MOC-31、Ber-EP4和CD-15具有统计学意义。使用HBME-1时，80%的AC呈阴性，而所有3例MS均呈强阳性反应，P = ＜0.003。血栓调节蛋白检测时P = 0.02，76.5%的AC无免疫反应。Ber-EP4和MOC-31的检测结果良好，P分别＜0.001和0.01。CD-15检测时P = 0.034。使用其他抗体未发现差异。10例AC、所有3例MS和10例RM成功进行了HBME-1和/或MOC-31与Ber-EP4的双重免疫染色。