Distinguishing benign from malignant mesothelial cells in effusions by Glut‐1, EMA, and Desmin expression: An evidence‐based approach

Abstract

Distinguishing malignant mesothelioma (MM) from reactive mesothelial hyperplasia (RM) may be difficult in effusions. This study tested the hypothesis that immunocytochemistry (IC) in effusion cell blocks (CB) can distinguish MM from RM and that the results may be applied to individual specimens. External validation of a risk score (RS) model associating sensitivity and specificity was applied to an external set of MM and RM specimens from a separate institution. Forty three effusion cytology CBs of 25 confirmed malignant mesotheliomas were compared to CBs of 23 benign mesothelial effusions without inflammation and 13 reactive mesothelial proliferations associated with inflammation. Glut-1, EMA, and Desmin expression were evaluated by immunocytochemistry on CBs. Each antibody was compared using ROC values, where the area under the curve (AUC) was 0.90, 0.82, and 0.84 for Glut-1, EMA, and Desmin, respectively. Logistic regression (LR) analysis was applied to a combination of Glut-1 and EMA. A combined ROC curve was modeled for Glut-1 and EMA (AUC = 0.93). A RS = 2 × (Glut-1%) + 1 × (EMA%) was created from this ROC curve. When applied to an external set of MM and RM, the RS resulted in an ROC with AUC = 0.91. In conclusion, a RS derived from a LR of Glut-1 and EMA IC greatly improves the distinction between MM from RM cells in individual effusions. The study illustrates principles of evidence-based pathology concerning internal and external test performance in the differential diagnosis of MM versus RM.

Practical utility of insulin‐like growth factor II mRNA‐binding protein 3, glucose transporter 1, and epithelial membrane antigen for distinguishing malignant mesotheliomas from benign mesothelial proliferations

“…The sensitivity of GLUT‐1 ranged from 40 to 100%, while the specificity from 63 to 100% (Table ) . Kato et al .…”

“…The sensitivity and specificity of EMA has been reported in 68 to 100% and 40 to 100% for malignant mesothelioma . Hasteh et al .…”

“…reported that EMA was positive in all 52 mesotheliomas and 9% of 64 benign cases. But, Kuperman et al . showed that EMA was expressed in 77% of 43 mesotheliomas and 31% of 35 benign effusions.…”

“…The specificity of IMP3 is quite acceptable, but the sensitivity of IMP3 is not satisfactory except in Hanley et al 10 The sensitivity of GLUT-1 ranged from 40 to 100%, while the specificity from 63 to 100% (Table 6). 12,13,[15][16][17][18][19][20][21][22] Kato et al 17 showed that GLUT-1 was positive in all 48 mesotheliomas. However, the large study by Lagana et al 19 showed that GLUT-1 was expressed in 53% in mesotheliomas.…”

Molecular markers and new diagnostic methods to differentiate malignant from benign mesothelial pleural proliferations: a literature review

“…Kuperman et al performed, on PEs, a combined receiver operating characteristic (ROC) curve analysis and found a higher area under the curve (AUC) for GLUT-1 and EMA combination (0.93) than for GLUT-1 (0.90) and EMA (0.82) used separately. They additionally reported an AUC of 0.84 for desmin (20). Chang et al determined that the combination of IMP3/EMA, GLUT-1/EMA, and IMP3/GLUT-1 had a sensitivity of 66%, 53% and 45%, respectively (5).…”