Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Cancer Med. 2023 Mar;12(5):5334-5340. doi: 10.1002/cam4.5353. Epub 2022 Oct 19.
Pleural mesothelioma (PM) is typically diagnosed late during the disease. Earlier detection can increase the chance of effective therapy. Recurrent pleural effusions are the earliest symptoms displaying an array of cytomorphological changes from reactive atypia to malignancy. Diagnosis is possible on effusion cytology by applying molecular and immunocytochemical markers, the main difficulty being when to suspect PM and to differentiate PM from metastatic adenocarcinoma and reactive mesothelial proliferations.
We evaluated the diagnostic performance of two immunocytochemical dual stains (BerEp4/Calretinin and Desmin/Epithelial Membrane Antigen (EMA)) on 149 ethanol-fixed cytospin preparation as an initial step to solve the mentioned diagnostic difficulty. The immunocytochemical reactivity pattern was evaluated by two independent investigators. The final diagnosis corresponded to PM (n = 20), metastatic adenocarcinoma (n = 83), and mesotheliosis (n = 46) in these cases.
Calretinin had 99% specificity and 98% sensitivity for indicating a mesothelial phenotype, while BerEp4 distinguished the adenocarcinoma cases with 98% specificity and 99% sensitivity. EMA displayed 96% specificity and 99% sensitivity in malignant cases, while Desmin without EMA present showed 99% specificity and 96% sensitivity for indicating benign mesothelial proliferation.
Interpretation of the four immunoreactions is improved when performed as dual stains. The dual staining is a useful tool in the initial handling of atypical effusions and guides the subsequent choice of antibody panels for more detailed subclassification of malignant effusions.
胸膜间皮瘤（PM）通常在疾病晚期诊断。早期发现可以增加有效治疗的机会。复发性胸腔积液是最早出现一系列从反应性异型性到恶性的细胞形态学变化的症状。通过应用分子和免疫细胞化学标志物，可以在胸腔积液细胞学检查中进行诊断，主要困难在于何时怀疑 PM 并将 PM 与转移性腺癌和反应性间皮增生区分开来。
我们评估了两种免疫细胞化学双重染色（BerEp4/Calretinin 和 Desmin/Epithelial Membrane Antigen (EMA)）在 149 例乙醇固定细胞旋涂标本上的诊断性能，作为解决上述诊断困难的初始步骤。两名独立的研究者评估了免疫细胞化学反应模式。最终诊断为 PM（n=20）、转移性腺癌（n=83）和间皮瘤（n=46）。
Calretinin 对指示间皮表型的特异性为 99%，敏感性为 98%，而 BerEp4 则以 98%的特异性和 99%的敏感性区分腺癌病例。EMA 在恶性病例中显示出 96%的特异性和 99%的敏感性，而没有 EMA 存在的 Desmin 对指示良性间皮增生的特异性为 99%，敏感性为 96%。
当作为双重染色进行时，对四种免疫反应的解释得到了改善。双重染色是处理非典型胸腔积液的初始有用工具，并指导随后选择抗体面板对恶性胸腔积液进行更详细的分类。
