Diagnostic Accuracy of Ber-EP4 for Metastatic Adenocarcinoma in Serous Effusions: A Meta-Analysis

Abstract

Numerous studies have investigated the utility of Ber-EP4 in differentiating metastatic adenocarcinoma (MAC) from malignant epithelial mesothelioma (MM) and/or reactive mesothelial cells (RM) in serous effusions. However, the results remain controversial. The aim of this study is to determine the overall accuracy of Ber-EP4 in serous effusions for MAC through a meta-analysis of published studies. Publications addressing the accuracy of Ber-EP4 in the diagnosis of MAC were selected from the Pubmed, Embase and Cochrane Library. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analysis was performed by Meta-Disc 1.4 and STATA 12.0 softwares. 29 studies, based on 2646 patients, met the inclusion criteria and the summary estimating for Ber-EP4 in the diagnosis of MAC were: sensitivity 0.8 (95% CI: 0.78–0.82), specificity 0.94 (95% CI: 0.93–0.96), positive likelihood ratio (PLR) 12.72 (95% CI: 8.66–18.7), negative likelihood ratio (NLR) 0.18 (95% CI: 0.12–0.26) and diagnostic odds ratio 95.05 (95% CI: 57.26–157.77). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.91; the area under the curve was 0.96. Our findings suggest that BER-EP4 may be a useful diagnostic adjunctive tool for confirming MAC in serous effusions.

Diagnostic Accuracy of a Limited Immuno-panel of Calretinin and Ber-EP4 for Diagnosis of Malignant Effusions

“…However, its use in combination with a mesothelial marker is recommended for better diagnosis. 23 As far as mesothelial markers are concerned, results indicated that Calretinin is specific and sensitive marker for reactive and neoplastic mesothelial cells. 24,25 The number of antibodies that can be used in immunocytochemistry has increased dramatically over the past few years, and the future of diagnostic cytopathology will continue to expand as more and more immunohistochemical markers are validated and experimentally proved to be used.…”

Human epididymis protein 4 immunostaining of malignant ascites differentiates cancer of Müllerian origin from gastrointestinal cancer

“…Performing a paracentesis of ascites to obtain a sample for diagnosis is a common and easy procedure. Immunohistochemistry (IHC) or immunocytochemical analysis is helpful in the differential diagnosis between mesothelial cells and a variety of tumor types, and often involves the use of a panel of antibodies instead of individual markers: Ber‐Ep4 (usually for adenocarcinomas and cancers of the glandular epithelium), Wilms tumor gene 1 (WT1) (for high‐grade serous adenocarcinoma and that of the mesothelium), estrogen receptor (ER) (for gynecological and breast cancers), cytokeratin (CK) 7 (for gynecological, upper gastrointestinal, lung, and mesothelial cell), CK20 (for lower gastrointestinal and mucinous adenocarcinoma), and caudal type homeobox 2 (CDX2) (for lower and upper gastrointestinal, mucinous adenocarcinoma) . Other IHC markers that are commonly used are cancer antigen 125 (CA125), which mainly identifies epithelium of gynecological origin, and carcinoembryonic antigen (CEA), which mainly identifies epithelium of gastrointestinal origin.…”

Serous cystadenocarcinoma of the spleen

“…The patient had normal serum CEA and CA 19-9 levels, which indicated lower possibility of intestinal or pancreatic adenocarcinoma. A positive Ber-EP4 immunochemical stain almost excluded a mesothelium-origin malignancy [13] . The presumed tumor origins of mucinous cystadenocarcinoma of the spleen were not applicable in our case.…”