BACKGROUND: The sensitivity of conventional cytology for the detection of malignant cells in pleural effusion is insufficient. GLUT1 and CAIX are the hallmarks of metabolic change in cancer cells. The aim of this study was to evaluate the usefulness of GLUT1 and CAIX expression to the detection of cancer cells in pleural effusions. METHODS: A total of 150 pleural effusions were subjected to immunocytochemical staining for GLUT1 and CAIX expression. According to their cytological diagnosis and etiology, these included 58 benign effusions, 38 probable malignant effusions, 7 atypical effusions, and 47 malignant effusions,. RESULTS: None of the benign effusions showed GLUT1 or CAIX expression, but probable malignant effusions and malignant effusions significantly expressed GLUT1 and CAIX with a positive result in 74.5% and 63.8% of the malignant effusions, respectively, with 100% specificity. When the combination of both markers was evaluated, GLUT1 and CAIX displayed a higher diagnostic performance, ie, a sensitivity of 76.6%, specificity of 100%, and accuracy of 89.5%. A statistically significant positive correlation between GLUT1 and CAIX expression was observed. In addition, 18% of cases with cells resembling mesothelial cell hyperplasia in probable malignant effusions and 71.4% of cases with atypical cells of uncertain significance in atypical effusions were highlighted on GLUT1 or/and CAIX immunocytochemical stains. CONCLUSIONS: Immunocytochemical staining for GLUT1 and CAIX may be a complementary tool for the detection of malignant pleural effusions and is helpful in distinguishing cancer cells from reactive mesothelial cells. A combination of GLUT1 and CAIX immunocytochemical staining can give a higher diagnostic performance. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.
BACKGROUND: Carbonic anhydrase IX (CAIX) is a hallmark of metabolic change in cancer cells. The aim was to evaluate the utility of CAIX expression for the detection of malignant pleural effusions by enzyme-linked immunosorbent assay (ELISA) and immunocytochemistry. METHODS: A total of 97 pleural effusions including 54 benign effusions, 10 atypical effusions, and 33 malignant effusions, classified based on cytological diagnosis and etiology, were subjected to ELISA to measure protein level and to immunocytochemistry in cell blocks to determine CAIX expression. RESULTS: CAIX levels were significantly higher in the malignant group compared with the benign group. Receiver operating characteristic curve analysis of benign and malignant pleural effusion for CAIX indicated an area under the curve of 0.82 with a value of 1882 pg/dL as the best threshold for distinguishing benign from malignant effusions, which yields a sensitivity, specificity, and accuracy of 63.6%, 94.4%, and 82.8%, respectively. None of the benign effusion expressed CAIX by immunocytochemistry.
BACKGROUND: Glucose transporter 1 (GLUT1) is a hallmark of metabolic change in cancer cells. The objective of this study was to determine the role of GLUT1 protein in diagnosing malignant pleural effusions by enzyme-linked immunosorbent assay (ELISA) and immunocytochemistry. METHODS: In total, 82 pleural effusions were collected and classified as benign (n 5 42), atypical (n 5 8), or malignant (n 5 32) based on cytologic diagnosis and etiology. GLUT1 protein levels in effusions were measured by ELISA. GLUT1 expression also was determined by immunocytochemistry using cell blocks.RESULTS: GLUT1 levels were significantly higher in the malignant group compared with the benign group. Receiver operating characteristic curve analysis of benign and malignant pleural effusions for GLUT1 yielded an area under the curve of 0.77, with a value of 1355.87 pg=dL as the optimal threshold for distinguishing benign from malignant effusions. With the ELISA method, the sensitivity, specificity, and accuracy were 78.1%, 69%, and 73%, respectively. Malignant effusion cell blocks were positive for GLUT1 expression in 84.4% of cases with 100% specificity and 93.2% accuracy. With the combination of high GLUT1 protein levels (>10,000 pg=dL) and immunocytochemistry to detect malignant pleural effusions, the sensitivity and accuracy increased to 93.8% and 94.6%, respectively. The GLUT1 level measured by ELISA and the GLUT1 expression detected by immunocytochemistry were positively correlated. In atypical effusions, 3 cases (37.5%) had GLUT1 levels higher than the cutoff value. CONCLUSIONS: The detection of GLUT1 protein by ELISA and immunocytochemistry may have utility in the diagnosis of malignant pleural effusions. Cancer (Cancer Cytopathol) 2013;121:695-702. V C 2013 American Cancer Society.
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