Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Nov;28(6):410-6.
doi: 10.5001/omj.2013.117.

Evaluation of the sensitivity and specificity of immunohistochemical markers in the differential diagnosis of effusion cytology

Zahraa Mohammed Yahya  1 , Hussam Hasson Ali, Haider Ghazi Hussein
Affiliations

Evaluation of the sensitivity and specificity of immunohistochemical markers in the differential diagnosis of effusion cytology

Zahraa Mohammed Yahya et al. Oman Med J. 2013 Nov.

Abstract

Objective: To evaluate the sensitivity and specificity of Calretinin and Carcinoembryonic antigen as immunocytochemical markers in distinguishing mesothelial cells from metastatic adenocarcinoma cells in effusion cytology.

Methods: This study included 50 patients who presented with effusions (26 pleural and 24 peritoneal), at Al-Kadhimya Teaching Hospital who were selected according to their preliminary diagnosis from 1st December 2010 to 30th June 2011. Effusion fluids were aspirated and processed for both conventional cytological methods using Papanicolaou-stain and immunocytochemical staining with anti Calretinin and Carcinoembryonic antigen.

Results: The sensitivity of cytology for detection of malignant cells was 77%, with 100% specificity and 86% accuracy. Calretinin was observed to be a specific (100%) and sensitive (90%) marker for mesothelial cells (of benign etiology). Carcinoembryonic antigen exhibited 70% sensitivity and 100% specificity for adenocarcinoma cells. When the results of both cytology and immunocytochemistry were considered in conjunction, the sensitivity for the detection of malignancy increased to 97%, with 100% specificity and 98% accuracy.

Conclusion: Calretinin and Carcinoembryonic antigen were found to be useful markers for differentiating reactive mesothelial cells from metastatic adenocarcinoma cells in smears prepared from body fluids. Also, the combination of both cytology and immunocytochemical studies using the two markers can greatly enhance the diagnostic accuracy, sensitivity and specificity in malignant effusions.

Keywords: Adenocarcinoma; Calretinin; Carcinoembryonic antigen; Effusion; Mesothelial Cells.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cause of hemorrhagic effusions in cases studied.
Figure 2
Figure 2
Color of fluid in metastatic adenocarcinoma effusions in cases studied.
Figure 3
Figure 3
Reactive ascitic fluid showing: a- Cluster of benign looking reactive mesothelial cells with low nuclear to cytoplasmic ratio (arrows) (Pap40×). b- Positive immunocytochemical expression of CAL with brown cytoplasmic and nuclear staining with strong intensity (arrows) (40×). c- Reactive mesothelial cells with negative immunocytochemical expression of CEA (arrow) (40×).
Figure 4
Figure 4
Suspicious ascitic fluid*showing: a- Cluster of few atypical cells with mild to moderate pleomorphism & relative high nuclear to cytoplasmic ratio (arrows) (Pap 40 ×). b- Positive immunocytochemical expression of CAL with brown cytoplasmic and nuclear staining with strong intensity (arrow) (40×). c- Negative immunocytochemical expression of CEA (arrow) (40×). * Final diagnosis was reactive effusion.
Figure 5
Figure 5
Suspicious ascitic fluid* showing: a- Cluster of atypical cells with moderate pleomorphism, some with high nuclear to cytoplasmic ratio & prominent nucleoli (arrows) (Pap 40×). b- Negative immunocytochemical expression of CAL (arrow) (40×). c- Positive immunocytochemical expression of CEA with brown cytoplasmic staining with moderate intensity (arrow) (40×). * Final diagnosis was Metastatic Adenocarcinoma effusion.
Figure 6
Figure 6
Malignant pleural fluid showing: a- Cluster of malignant epithelial cells with marked pleomorphism, high nuclear to cytoplasmic ratio, hyperchromasia and prominent nucleoli (arrows) (Pap 40 ×). b- Negative immunocytochemical expression of CAL (arrow) (40×). c- Positive immunocytochemical expression of CEA with brown cytoplasmic staining with strong intensity (arrows) (40X).
See this image and copyright information in PMC

References

    1. Shidham VB, Falzon M. Serous effusions. In: Gray W, Kocjan G: editors. Diagnostic Cytopathology, 3rd Edition. Churchill Livingstone, Elsevier 2010; p 115-175.
    1. He DN, Zhu HS, Zhang KH, Jin WJ, Zhu WM, Li N, et al. E-cadherin and calretinin as immunocytochemical markers to differentiate malignant from benign serous effusions. World J Gastroenterol 2004. Aug;10(16):2406-2408 - PMC - PubMed
    1. Butnor KJ. My approach to the diagnosis of mesothelial lesions. J Clin Pathol 2006. Jun;59(6):564-574 10.1136/jcp.2005.029652 - DOI - PMC - PubMed
    1. Lyons-Boudreaux V, Mody DR, Zhai J, Coffey D. Cytologic malignancy versus benignancy: how useful are the "newer" markers in body fluid cytology? Arch Pathol Lab Med 2008. Jan;132(1):23-28 - PubMed
    1. Murugan P, Siddaraju N, Habeebullah S, Basu D. Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: a combination panel-based approach with a brief review of the literature. Indian J Pathol Microbiol 2009. Apr-Jun;52(2):175-181 10.4103/0377-4929.48910 - DOI - PubMed

LinkOut - more resources