Takano Gustavo Henrique Soares, Amorim Rivadávio Fernandes, Ferreira Vânia Moraes, Vianna Leonora Maciel de Souza, de Castro Tercia Maria Mendes Lousa, Carneiro Marcos de Vasconcelos, Oliveira Ísis de Araújo, Motoyama Andrea Barretto, Carneiro Fabiana Pirani
Pathological Anatomy Unit of University Hospital of Brasilia Brasília 999074, Brazil.
Pathology Department of Brasília University Brasília 999074, Brazil.
Int J Clin Exp Pathol. 2022 Apr 15;15(4):191-200. eCollection 2022.
In women, most malignant effusions are from breast and ovary primary carcinomas that have metastasized to body cavity fluids (pleural, peritoneal and pericardial). When carcinoma is diagnosed in effusions, it is not possible to identify its site of origin solely by cytology (morphology); therefore, immunocytochemistry is used as a complementary method. There are no immunocytochemical markers with 100% sensitivity and specificity for identifying carcinoma primary site. The markers most used are TTF-1 for the lung, GATA-3 for the breast, and PAX-8 for the ovary. The aim of this study was to evaluate the sensitivity and specificity of a panel including these markers for detecting the primary site of carcinoma in effusions.
Samples of pleural, pericardial, and peritoneal effusions and peritoneal washings with carcinoma of known primary site from women (n = 60) and men (n = 18) were prepared by using the cell block method, and immunocytochemistry was performed to evaluate the expression of primary site markers (TTF-1, PAX-8, and GATA-3).
In women, the breast was the most frequent primary site of metastatic carcinoma to both pleural and pericardial cavities, followed by the lung, whereas the ovary was the most frequent primary site of carcinoma within peritoneal effusions and washings, followed by the gastrointestinal tract (stomach or intestine). The expected profiles for carcinomas of the most common primary sites were: breast (GATA-3 (+), PAX-8 (-), TTF-1 (-)), ovary (PAX-8 (+), GATA-3 (-), TTF-1 (-)), lung (TTF-1 (+), PAX-8 (-) GATA-3 (-)) and gastrointestinal tract (PAX-8 (-), GATA-3 (-), TTF-1 (-)). These were observed in 88.23% (45/51) of women's samples with carcinoma from these primary sites. By using TTF-1 as the sole primary site marker, 6.25% of carcinomas of primary site other than the lung would have been misdiagnosed.
An initial panel of markers including GATA-3, PAX-8, and TTF-1 allows, with high sensitivity and specificity, the identification or exclusion of frequent primary sites of carcinoma in effusions from women. Our results highlight the importance of using a panel of markers to avoid misidentification of the primary site of tumor.
在女性中，大多数恶性积液来自已转移至体腔液（胸膜、腹膜和心包）的乳腺和卵巢原发性癌。当在积液中诊断出癌时，仅通过细胞学（形态学）无法确定其起源部位；因此，免疫细胞化学被用作一种辅助方法。目前尚无对确定癌原发部位具有100%敏感性和特异性的免疫细胞化学标志物。最常用的标志物是用于肺的甲状腺转录因子-1（TTF-1）、用于乳腺的GATA-3和用于卵巢的配对盒基因8（PAX-8）。本研究的目的是评估包含这些标志物的一组标志物对检测积液中癌原发部位的敏感性和特异性。
采用细胞块法制备来自女性（n = 60）和男性（n = 18）的已知原发部位癌的胸膜、心包和腹膜积液及腹膜冲洗液样本，并进行免疫细胞化学以评估原发部位标志物（TTF-1、PAX-8和GATA-3）的表达。
在女性中，乳腺是转移至胸膜和心包腔的癌最常见的原发部位，其次是肺，而卵巢是腹膜积液和冲洗液中癌最常见的原发部位，其次是胃肠道（胃或肠）。最常见原发部位的癌的预期特征为：乳腺（GATA-3（+）、PAX-8（-）、TTF-1（-））、卵巢（PAX-8（+）、GATA-3（-）、TTF-1（-））、肺（TTF-1（+）、PAX-8（-）、GATA-3（-））和胃肠道（PAX-8（-）、GATA-3（-）、TTF-1（-））。在这些原发部位的女性癌样本中，88.23%（45/51）观察到了这些特征。以TTF-1作为唯一的原发部位标志物，6.25%的非肺原发部位的癌会被误诊。
包括GATA-3、PAX-8和TTF-1的一组初始标志物能够以高敏感性和特异性识别或排除女性积液中癌的常见原发部位。我们的结果强调了使用一组标志物以避免肿瘤原发部位错误识别的重要性。
