Pathology Department, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Acta Cytol. 2023;67(3):265-272. doi: 10.1159/000528061. Epub 2023 Jan 10.
Malignant serous effusions are common in metastatic carcinomas. Although cytomorphology is recognized as the gold standard diagnostic method, it exhibits moderate sensitivity. This study aimed to assess the diagnostic value of immunophenotyping with a single epithelial marker, known as the epithelial cell adhesion molecule (EpCAM, CD326), in discriminating malignant metastatic carcinomas of serous fluids.
This prospective study was conducted on suspicious or confirmed cases of malignant tumors from September 16, 2019, to June 21, 2020. Serous fluid samples were assessed via cytomorphology using the Wright-Papanicolaou method and the anti-EpCAM mouse monoclonal antibody (clone VU-1D9) flow cytometry. The EpCAM(+)/CD45(-) immunophenotype was defined as the metastatic involvement of carcinoma in the serous cavity.
A total of 118 samples (90 females and 28 males; mean age, 54.04 ± 16.14 years), collected from peritoneal and pleural fluids, were examined in this study. Five samples (4.24%) were positive in both EpCAM flow cytometry and cytology, while 102 samples (86.44%) were negative for both EpCAM flow cytometry and cytology, yielding an overall agreement of 92%, 84%, and 90.7% for the peritoneal, pleural, and total samples, respectively. Based on the Bayesian latent class model, the EpCAM flow cytometry showed sensitivity and specificity of 58.5% (95% CI: 0.3, 99.7) and 96.2% (95% CI: 47.8, 100), respectively. The corresponding values were 68.7% (95% CI: 0.3, 99.9) and 96.1% (95% CI: 47, 100) for cytology, respectively.
The EpCAM flow cytometry and cytology showed comparable performance in detecting metastatic effusions. The EpCAM flow cytometry might have a diagnostic value in decreasing the false-negative rate of cytomorphology, while maintaining excellent specificity.
恶性浆膜腔积液在转移性癌中很常见。虽然细胞形态学被认为是金标准诊断方法，但它的灵敏度中等。本研究旨在评估上皮细胞黏附分子（EpCAM，CD326）作为单一上皮标志物的免疫表型在鉴别浆膜腔恶性转移性癌中的诊断价值。
本前瞻性研究于 2019 年 9 月 16 日至 2020 年 6 月 21 日对可疑或确诊的恶性肿瘤病例进行。浆膜腔液标本通过 Wright-Papanicolaou 法和抗 EpCAM 鼠单克隆抗体（克隆 VU-1D9）流式细胞术进行细胞学评估。EpCAM(+) / CD45(-)免疫表型被定义为癌在浆膜腔中的转移累及。
本研究共检查了 118 例（90 例女性，28 例男性；平均年龄 54.04±16.14 岁）来自腹膜和胸腔积液的样本。5 例（4.24%）EpCAM 流式细胞术和细胞学均为阳性，而 102 例（86.44%）EpCAM 流式细胞术和细胞学均为阴性，腹膜、胸腔和总样本的总符合率分别为 92%、84%和 90.7%。基于贝叶斯潜在类别模型，EpCAM 流式细胞术的敏感性和特异性分别为 58.5%（95%CI：0.3，99.7）和 96.2%（95%CI：47.8，100）。细胞学的相应值分别为 68.7%（95%CI：0.3，99.9）和 96.1%（95%CI：47，100）。
EpCAM 流式细胞术和细胞学在检测转移性积液方面具有相当的性能。EpCAM 流式细胞术可能具有降低细胞形态学假阴性率的诊断价值，同时保持优异的特异性。
