Useful Application of Immunostaining to Malignant Pleural Effusion among Lao People in Vientiane Capital, Lao PDR

Our plain-English summary of Useful Application of Immunostaining to Malignant Pleural Effusion among Lao People in Vientiane Capital, Lao PDR, by S. Vilayvong, K. Hando, M. Sekine, et al (Asian Pacific Journal of Cancer Prevention, 2019).

The study

• Authors: S. Vilayvong, K. Hando, M. Sekine, T. Luangxay, P. Arounlangsy, P. Xaysomphet, P. Xayaphet, H. Thavisouk, Y. Soejima, M. Kitagawa, M. Sawabe
• Journal: Asian Pacific Journal of Cancer Prevention
• Published: 2019;20(1):243-248
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pathology and laboratory medicine (PALM) services are limited in low-resource countries, such as Lao PDR. Patients with malignant pleural effusion (MPE) are not properly diagnosed and treated in these situations. The purpose of this study is to confirm the usefulness of immunocytochemistry in MPE to identify the histological type and probable primary site of cancer of MPE and to discuss its usefulness in low-resource countries, such as Laos. Methods: We retrospectively reviewed glass slides of pleural effusion sent to the Department of Pathology at the University of Health Sciences from the central hospitals for cytological screening from January 2012 to December 2016. The cytological review, cell transfer and immunocytochemical staining were performed at Tokyo Medical and Dental University. Among 81 cases of MPE from Laos, 66 cases of malignant tumors that contained enough tumor cells were included in this study, and the slides were screened with 14 primary antibodies to classify the histological type and identify the probable primary site of carcinoma. Results: Among the 66 cases, 34 cases (52%) were of female patients, and 32 cases (48%) were of male patients. The patients’ ages ranged from 28 to 88 years with an average of 58 years. The immunocytochemical study identified 32 cases (49%) of primary lung adenocarcinoma, two cases (3%) of malignant mesothelioma, one case (1.5%) of breast/gynecological carcinoma, one case (1.5%) of T cell lymphoma, and one case (1.5%) of B cell lymphoma. Twenty-nine cases (43.5%) were classified as carcinoma not otherwise specified. Pulmonary small cell carcinoma/squamous cell carcinoma and metastatic colon, prostate, and liver carcinoma were not identified among the cases. Conclusions: Immunocytochemistry is a useful ancillary method in MPE diagnostics. This method could be applied in the pathological laboratories in low- or middle-resource countries, such as Laos.

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In plain English

This retrospective study, by researchers in Laos and Japan, re-examined glass slides of fluid from around the lungs (pleural effusion). The slides had been sent from central hospitals to the pathology laboratory of the University of Health Sciences in Vientiane Capital, Lao PDR, between January 2012 and December 2016. Of 81 cases suspected or positive for cancer, 66 had enough tumor cells to study. Of these, 34 were women and 32 were men, aged 28 to 88. At Tokyo Medical and Dental University, the cells were moved to new slides and stained with up to 14 antibody markers to identify each cancer's type and likely origin. The markers identified 32 cases (49%) as lung adenocarcinoma and two cases (3%) as malignant mesothelioma. They identified one case each (1.5%) as breast or gynecological carcinoma, B cell lymphoma and T cell lymphoma. The other 29 cases (43.5%) stayed unclassified. The article did not study asbestos or any other exposure. The authors noted that clinical information, imaging films and some data such as age were missing. The authors concluded that this staining method was useful and could be applied even in low- and middle-income countries.

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: Retrospective laboratory study re-examining stored pleural effusion cytology slides using immunocytochemistry (antibody staining)
• Who was studied: Pleural effusion slides sent from central hospitals to the Department of Pathology, University of Health Sciences, Vientiane Capital, Lao PDR, January 2012 to December 2016. Of 81 cases suspected or positive for malignancy, 66 with enough malignant cells were studied: 34 female and 32 male patients, aged 28 to 88 years (average 58). Of these, 40 were from Vientiane Capital and 26 from other provinces.
• Exposure: No exposure was studied. The article does not mention asbestos or any occupational or environmental exposure. The study tested 14 antibody markers (including Calretinin and D2-40 for malignant mesothelioma) on the slides.
• Main results:
  • Among the 66 cases, staining identified 32 cases (49%) of primary lung adenocarcinoma, two cases (3%) of malignant mesothelioma, and one case each (1.5%) of gynecological carcinoma, B cell lymphoma and T cell lymphoma.
  • The remaining 29 of the 66 cases (43.5%) could not be classified and were called carcinoma not otherwise specified.
  • The two malignant mesothelioma cases were the two cases positive for the mesothelioma markers Calretinin and D2-40.
  • Of 15 female cases among the 32 non-lung carcinoma cases screened for estrogen receptor (ER), only one was positive. That case was negative for the breast marker GCDFP-15.
  • The 29 unclassified carcinoma cases were all negative for markers of squamous cell carcinoma, small cell and neuroendocrine tumors, liver cancer and colon cancer. The male cases among them were also negative for the prostate marker.
• The authors' conclusion: The authors concluded that immunocytochemistry was an effective and useful method in diagnosing malignant pleural effusion. They found it gave the tumor type and origin in at least half of cases, and they stated it was applicable even in low- and middle-income countries.
• Limitations the authors state:
  • Patients' clinical information and medical imaging films were missing.
  • Some data, such as patient age, were missing because samples were brought to a laboratory separate from the hospitals.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pathology, Carcinoma, Lung Adenocarcinoma, Mesothelioma, Squamous Cell Carcinoma.

Related studies

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• Small orangiophilic squamous-like cells: an underrecognized and useful morphological feature for the diagnosis of malignant mesothelioma in pleural effusion cytology — L. Chen, S.G. Caldero, et al. (2014)
• Using creative co-design to develop a decision support tool for people with malignant pleural effusion — C. Grindell, A. Tod, et al. (2020)
• Wilms tumor 1/cytokeratin dual-color immunostaining reveals distinctive staining patterns in metastatic melanoma, metastatic carcinoma, and mesothelial cells in pleural fluids: an effective first-line test for the workup of malignant effusions — J.R. Conner, E.S. Cibas, et al. (2014)
• Podoplanin is a useful marker for identifying mesothelioma in malignant effusions — A. Hanna, Y. Pang, et al. (2010)
• EZH2, a unique marker of malignancy in effusion cytology — H. Jiang, R. Gupta, et al. (2014)

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