Modified Liquid-Based Cytology Technique for Immunocytochemistry in Effusion Specimen

Our plain-English summary of Modified Liquid-Based Cytology Technique for Immunocytochemistry in Effusion Specimen, by N. Patarapadungkit, P. Jangsiriwitayakorn, S. Chaiwiriyakul, et al (Asian Pacific Journal of Cancer Prevention, 2019).

The study

• Authors: N. Patarapadungkit, P. Jangsiriwitayakorn, S. Chaiwiriyakul, P. Sirivech, R. Thongbor, E.O. Phanomsri, L. Nititarakul
• Journal: Asian Pacific Journal of Cancer Prevention
• Published: 2019;20(9):2611-2617
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Immunocytochemistry (ICC) of serous effusion is an important tool for the diagnosis of benign and malignant cells. Our aim was to develop a modified liquid-based cytological technique for ICC (i.e., a modified LBC). Methods: Serous effusions of 110 cases were collected for cytological examination: 50 were negative for malignancy albeit benign mesothelium was found, and 60 were confirmed metastatic adenocarcinoma according to the modified LBC preparation. The latter were stained for EMA, Ber-EP4, Calretinin, and p63 then interpreted by both a cytotechnologist and a pathologist. A comparative analysis of the diagnostic results was conducted. Results: The results of the metastatic adenocarcinoma were 100% (60/60) positive for EMA and 91.7% (55/60) positive for Ber-Ep4 but negative for calretinin and p63. Cases negative for malignancy were 100% (50/50) positive for calretinin but negative for carcinoma markers. The difference between ‘positive for metastatic adenocarcinoma’ and ‘negative for malignancy’ in ICC was statistically significant (p < 0.001). Conclusion: The current study demonstrated that a panel marker, comprising EMA, Ber-EP4, and calretinin can be used for differentiating between cases of metastatic adenocarcinoma and benign mesothelium. The serous effusion specimen collected by the modified LBC technique is an effective preparation method for ICC.

In plain English

This laboratory study from Khon Kaen University, Thailand, tested a low-cost way of preparing body-fluid samples for immunocytochemistry, a staining technique that helps tell cell types apart. The preparation was a modified liquid-based cytology method using ethanol and normal saline. The authors used fluid from around the lungs, abdomen or heart of 110 patients at Srinagarind Hospital, collected between August 2014 and March 2016. Sixty were cases of metastatic adenocarcinoma, a cancer that had spread from another organ, and 50 were benign cases containing mesothelial cells. Samples were stained for four markers: EMA, Ber-EP4, calretinin and p63. EMA was positive in all 60 adenocarcinoma cases and in none of the 50 benign cases. Ber-EP4 was positive in 55 of the 60 adenocarcinoma cases and in no benign cases. Calretinin was positive in all 50 benign cases and in no adenocarcinoma cases. p63 was negative in every case. The authors concluded that a panel of EMA, Ber-EP4 and calretinin can be used to tell metastatic adenocarcinoma from benign mesothelium, and that the modified preparation worked well for this staining. The study included no mesothelioma cases and did not look at asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Laboratory diagnostic study of a cell-preparation method and an immunocytochemistry marker panel on serous effusion samples
• Who was studied: Serous effusion samples from 110 patients at Srinagarind Hospital, Thailand, collected August 2014 to March 2016: 50 negative for malignancy with benign mesothelium and 60 metastatic adenocarcinoma. Patients were aged 27 to 89 (mean 55.9). Samples were 54 pleural, 50 peritoneal and 6 pericardial fluids.
• Exposure: No asbestos or other environmental exposure was studied. The subject was a modified liquid-based cytology preparation using ethanol and normal saline, followed by staining for EMA, Ber-EP4, calretinin and p63. A result counted as positive when more than 10% of cells stained.
• Main results:
  • EMA was positive in all 60 metastatic adenocarcinoma cases and negative in all 50 benign mesothelial cases.
  • Ber-EP4 was positive in 55 of 60 metastatic adenocarcinoma cases (91.7%) and negative in all 50 benign cases.
  • The 5 adenocarcinoma cases negative for Ber-EP4 were 2 breast cancers, 1 endometrial cancer, 1 lung cancer and 1 of unknown origin.
  • Calretinin was positive in all 50 benign mesothelial cases (100%) and in none of the 60 metastatic adenocarcinoma cases.
  • p63 was negative in all 60 adenocarcinoma cases and all 50 benign cases.
  • EMA, Ber-EP4 and calretinin differed significantly between adenocarcinoma and benign mesothelial cases (p less than 0.001). p63 did not (p greater than 0.999).
• The authors' conclusion: The authors concluded that a panel of EMA, Ber-EP4 and calretinin can be used to differentiate metastatic adenocarcinoma from benign mesothelium, and that the modified liquid-based preparation gave effective immunocytochemical diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytology, Mesothelium, Adenocarcinoma, Ber-EP4, Calretinin, Carcinoma.

Related studies

• The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience — E.D. Rossi, T. Bizzarro, et al. (2015)
• The application of immunocytochemistry to direct smears in the diagnosis of effusions — S.M. Knoepp, J. Placido, et al. (2013)
• Utility of BAP1 Immunohistochemistry and p16 (CDKN2A) FISH in the Diagnosis of Malignant Mesothelioma in Effusion Cytology Specimens — H.C. Hwang, B.S. Sheffield, et al. (2016)
• Investigating unilateral pleural effusions: the role of cytology — D.T. Arnold, D. De Fonseka, et al. (2018)
• Detection of malignant mesothelioma using nuclear structure of mesothelial cells in effusion cytology specimens — A.B. Tosun, O. Yergiyev, et al. (2015)
• The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology — T.S. Hyun, M. Barnes, et al. (2012)

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