Diagnostic accuracy of SATB2 in identifying primary and metastatic colorectal carcinoma: a comparative immunohistochemical study

Abstract

Special AT-rich sequence-binding protein 2 (SATB2) is a new marker that could identify the colonic origin, but whether its expression is preserved in metastatic colorectal carcinomas (CRCs) remains unclear. This study was designed to investigate SATB2 validity in the identification of CRC either alone or in combination with caudal-type homeobox 2 (CDX2) and/or cytokeratin 20 (CK20). Moreover, we examined the concordance of SATB2 expression in primary CRC and paired metastatic specimen. Immunohistochemical expression of SATB2, CDX2 and CK20 was evaluated in primary CRC, 50 paired metastatic CRC and 80 non-CRC specimens. This study demonstrated that the ideal SATB2 cut-off value for recognising colonic from non-colonic origin was 10%. SATB2 was more sensitive and specific than CK20. However, it was more specific but less sensitive than CDX2. Analysing the combined markers expression, SATB2 and CDX2 combination revealed better sensitivity, specificity and larger area under curve compared to SATB2 alone, CDX2 alone and combined CDX2 and CK20. Moreover, SATB2 was able to retain its expression at the metastatic sites. SATB2 was totally concordant between primary CRC and their paired metastatic sites (concordance rate = 100%) with perfect level of agreement. SATB2 could be considered as an accurate diagnostic marker of primary and metastatic CRC. SATB2 and CDX2 is the best combination serving the highest sensitivity and specificity in detection of CRC.

Immunohistochemical Evaluation of SATB2 Expression in Colorectal Carcinoma in Mosul City, Iraq

“…IHC studies of SATB2 on CRCs revealed that it is a sensi- tive and highly specific marker to confirm or rule out tumors of colorectal origin [9,[21][22][23]. SATB2 was expressed in 96% of the primary CRCs in a study done by Zhang et al [24] and 94.3% in a study done by Elnady et al [4]. Elaidy et al [25] found that 86.8% of CRC showed SATB2 expression.…”

“…T he malignant tumor of the colon and rectum is the third most common cancer worldwide [1][2][3][4], and regarding mortality, it is ranked the second most common cancer [ [1,5]. Although colorectal carcinoma (CRC) is successfully treated when diagnosed at early stages, it shows rapid progression with delayed appearance of clinical symptoms [2,6].…”

“…The SATB2 "special AT-rich sequence-binding protein 2", represents a transcription factor [9][10][11][12] that attaches to the DNA nuclear matrix attachment region and subsequently directs transcription and chromatin remodeling [3,4,[11][12][13]. The SATB2 gene is located on chromosome 2.…”

“…It was first identified in 2002 in complementary DNA sequencing [7]. SATB2 has a role in osteoblastic and craniofacial differentiation [4,15,16], and is also involved in the progression of the central nervous system [4,11,13]. Among the epithelial tissue, SATB2 is detected at a high level http://doi.org/10.33091/amj.2024.148426.1685 in the epithelium of the lower gastrointestinal tract and in malignant tumors [4,9,15].…”

“…SATB2 has a role in osteoblastic and craniofacial differentiation [4,15,16], and is also involved in the progression of the central nervous system [4,11,13]. Among the epithelial tissue, SATB2 is detected at a high level http://doi.org/10.33091/amj.2024.148426.1685 in the epithelium of the lower gastrointestinal tract and in malignant tumors [4,9,15]. It shows an expression restricted to colorectal/appendiceal adenocarcinomas, urothelial/renal carcinomas, and tumors that show osteoblastic differentiation [15].…”