Abstract
Differentiating reactive mesothelial cells (RMs) from metastatic adenocarcinoma cells (MAC) in serous fluids based on cytomorphologic features alone can be very challenging. Various immunocytochemical (ICC) markers have been used to maximize the diagnostic accuracy, however, cytopathologists still encounter difficulties in effusion cytologic diagnosis. The aim of this study was to evaluate previous and recent ICC stains to identify the most sensitive and specific markers and the best panel for differentiating RM from MAC.
Cell block sections from 41 MAC and 43 RM effusions cases were subjected to ICC staining for MOCβ31, BerEp4, carcinoembryonic antigen (CEA), calretinin, HBMEβ1, CK5/6, and D2β40. For the MAC cases, the sensitivity of BerEp4, MOCβ31, and CEA was 82.9, 92.6, and 17%, respectively, and the specificity was 95.3, 93, and 100%, respectively. For the RM cases, the sensitivity of calretinin, CK5/6, D2β40, and HBMEβ1 was 95.3, 27.9, 58.1, and 93%, respectively, and the specificity was 70.7, 73.1, 75.6, and 82.9%, respectively. The results show that BerEp4 and MOCβ31 are highly sensitive and specific for detecting MAC, whereas calretinin and HBME1 are highly sensitive but only modestly specific for detecting RM cases (P < 0.05). Forced entry logistic regression revealed that using MOCβ31, BerEp4, HBMEβ1, and calretinin, is an excellent panel for making correct diagnosis with 97.6% sensitivity in detecting MAC and 90.7% specificity in detecting RM.
We conclude that adding a panel of MOCβ31, BerEp4, calretinin, and HBMEβ1 immunostains to routine cytomorphologic features can greatly enhance the diagnostic accuracy of serous effusions. Diagn. Cytopathol. 2009. Β© 2009 WileyβLiss, Inc.