Identifying the primary site of malignancy in carcinomatous serous effusions using immunocytochemistry

Kundu, Reetu; Parwaiz, Amber; Gupta, Parikshaa; Rohilla, Manish; Gupta, Nalini; Srinivasan, Radhika; Dey, Pranab

doi:10.1111/cyt.13161

Cited by 3 publications

(6 citation statements)

References 23 publications

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“…Most cases of serous effusions are caused due to delayed hypersensitivity reaction to the tubercular antigen. The direct extension of the primary pulmonary tuberculosis to the pleural cavity is possibly the other mechanism [19]. In our study, 67 cases (15%) in the NFM category had a previous history of malignancy.…”

Section: Discussionmentioning

confidence: 51%

A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience

et al. 2022

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Introduction: The International Academy of Cytology and the American Society of Cytopathology recently proposed the International System for Reporting Serous Fluid Cytology (ISRSFC) to standardize serous fluid cytopathology reporting and guide further clinical management. The current study aimed to assess the feasibility of utilizing ISRSFC reporting categories for serous fluids, estimate the risk of malignancy (ROM) of each category, and scrutinize if the management protocols followed in our institution are as per the ISRFSFC recommendations. Methods: All pleural, peritoneal, and pericardial effusions submitted for evaluation at our institute between January 2021 and December 2021 were retrieved. All these cases were reviewed and re-categorized into one of the five categories proposed by the ISRSFC: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL), and ROM was calculated for each category. Results: The present study examined 596 serous effusions, of which 229 were pleural effusions, 358 were peritoneal effusions, and the remaining nine were pericardial effusions. Among 596 cases, 395 cases had a radiological or histological follow-up. The serous effusion samples were re-categorized as 61 (10.2%) ND, 449 (75.3%) NFM, 47 (7.8%) AUS, 17 (2.9%) SFM, and 22 (3.8%) MAL, and ROM for each above category were 10%, 4.4%, 19%, 83.3%, and 100%, respectively. Conclusion: Categorizing serous effusion cytology samples per the ISRSFC diagnostic categories reduces reporting variability. The ISRSFC provides a standardized format to predict the ROM and thus improves the quality of clinical care.

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Section: Discussionmentioning

confidence: 51%

A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience

et al. 2022

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“…Sitespecific IHC markers include TTF-1 (lung and thyroid), Napsin-A (lung and gynecologic clear cell carcinoma), GATA-3 (breast, urothelial, and parathyroid), uroplakins (urothelial), CDX-2 (gastrointestinal), WT-1 (gynecologic and mesotheliomas), and PAX8 (gynecologic, kidney, and thyroid). [2][3][4] None of these markers are 100% specific. PAX8 is the most used marker for a gynecologic origin, but it is also positive in renal and thyroid carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…A currently used IHC panel for diagnosing metastatic carcinomas in fluids includes carcinoma markers such as Claudin4, MOC31, and BerEP4, mesothelial markers (calretinin, WT‐1, and D2‐40), and other site‐specific markers to identify the origin of carcinomas. Site‐specific IHC markers include TTF‐1 (lung and thyroid), Napsin‐A (lung and gynecologic clear cell carcinoma), GATA‐3 (breast, urothelial, and parathyroid), uroplakins (urothelial), CDX‐2 (gastrointestinal), WT‐1 (gynecologic and mesotheliomas), and PAX8 (gynecologic, kidney, and thyroid) 2–4 . None of these markers are 100% specific.…”

Section: Discussionmentioning

confidence: 99%

“…Immunohistochemistry (IHC) stains are routinely used for diagnosing metastatic malignancies in cytology. [2][3][4] One of the most commonly used IHC markers to diagnose metastatic gynecologic malignancies is PAX8. 5 The sensitivity of PAX8 varies for different gynecologic carcinomas: 79%-99% for ovarian serous carcinoma, 76%-100% for ovarian clear cell carcinoma, 73%-100% for endometrial adenocarcinoma, and 50% for cervical adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

“…Cytologic evaluation is the mainstay for diagnosing malignant effusions and is important for staging, management, and prognosis. Immunohistochemistry (IHC) stains are routinely used for diagnosing metastatic malignancies in cytology 2–4 . One of the most commonly used IHC markers to diagnose metastatic gynecologic malignancies is PAX8 5 .…”

Section: Introductionmentioning

confidence: 99%

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SOX17 is a highly sensitive and specific marker for metastatic ovarian and endometrial carcinomas in cytology cell block specimens

Satturwar

Shaker

Sinclair

et al. 2023

Cancer Cytopathology

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Background: SOX17 (SRY-box transcription factor 17) was recently identified as a highly sensitive and specific marker for ovarian and endometrial carcinomas in surgical specimens. In this study, validation of the utility of SOX17 immunohistochemistry (IHC) in diagnosing metastatic gynecologic carcinomas in cytology specimens was sought. Methods:The study cohort included 84 cases of metastatic carcinomas that included 29 metastatic gynecologic carcinomas (24 ovarian high-grade serous carcinomas, two endometrial serous carcinomas, one low-grade serous carcinoma, one ovarian clear cell carcinoma, and one endometrial endometrioid carcinoma) and 55 cases of metastatic nongynecologic carcinomas (10 clear cell renal cell carcinomas, 10 papillary thyroid carcinomas, 11 gastrointestinal adenocarcinomas, 10 breast carcinomas, 10 lung adenocarcinomas, and four urothelial carcinomas). Cytology specimen types included peritoneal fluid (n = 44), pleural fluid (n = 25), and fineneedle aspiration (n = 15). SOX17 IHC was performed on the cell block sections.The intensity of staining and percent positivity of the tumor cells were evaluated.Results: SOX17 was highly expressed in all tested metastatic gynecologic carcinomas with diffuse and strong nuclear expression (29 of 29; 100%). SOX17 was negative in other metastatic nongynecologic carcinomas (54 of 55; 98.18%) except for one papillary thyroid carcinoma that showed low positivity (<10%).Conclusions: SOX17 is a highly sensitive (100%) and specific (98.2%) marker for the differential diagnosis of metastatic gynecologic carcinomas in cytology specimens.Therefore, SOX17 IHC should be included in the workup of differential diagnosis of metastatic gynecologic carcinomas in cytology specimens.

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Diagnostic Accuracy of Cell Block and Immunohistochemistry in Effusion Cytology

Batool¹,

Sadaf²,

Chughtai³

et al. 2023

Cureus

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IntroductionAlthough the cytology of effusion fluids is considered a routine laboratory test, it has recently emerged as an essential tool in determining the primary site of origin of carcinoma of unknown primary. The sensitivity for diagnosing malignancy has enhanced with the inclusion of cytospin, cell block (CB), and immunohistochemistry (IHC) to effusion fluid cytology due to the improvement in morphological preservation and good cellular yield. The purpose of this study was to assess the diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of IHC and CB in effusion cytology. MethodologyAn institution-based cross-sectional study was conducted over a period of six months on 150 cases of effusion fluids submitted for diagnostic purposes. After the preparation of cytospin, the residual amount of centrifuged deposit was mixed with CytoLyt solution, thrombin, and plasma, and CBs were prepared. IHC was applied to the CB. Calretinin was used for mesothelial cells, and BerEP4, TTF-1, ER, WT-1, and CD-X2 were used for the confirmation and origin of malignant cells. ResultsThe mean age of the patients was 51.75 ± 16.63 years. The male-to-female ratio was 1:1.24. Out of 150 cases, 78 were pleural effusions, 68 were peritoneal effusions, and four were pericardial effusions. Out of 150 cases, based on cytological examination alone, 66 (44%) were classified as benign, 27 (18%) as malignant, and 57 (38%) were suspicious for malignancy. When cytology was combined with CB and IHC, the diagnostic yield was increased to benign 95 (63.33%), malignant 48 (32%), and suspicious for malignancy 7 (4.67%). The most common cause of malignant pleural effusion was breast carcinoma in females and lung carcinoma in males. The most common primary tumor in malignant peritoneal effusion was ovarian carcinoma in females and colonic adenocarcinoma in males. The sensitivity and specificity of combined cytology with cell block and IHC were 92.31% and 98.95%, respectively. This combination produced significantly better results (pvalue = 0.001) for detecting malignancy and reduced suspicious cases from 38% to 4%. ConclusionCB, in combination with IHC, increases the diagnostic yield and aids in detecting malignancy at an unknown primary site in effusion fluids. Both of these techniques can thus enhance the sensitivity and specificity of the diagnosis of effusion cytology. Hence, CB and IHC have advanced utility over cytological smears in effusion fluid cytological diagnosis.

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Identifying the primary site of malignancy in carcinomatous serous effusions using immunocytochemistry

Cited by 3 publications

References 23 publications

A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience

A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience

SOX17 is a highly sensitive and specific marker for metastatic ovarian and endometrial carcinomas in cytology cell block specimens

Diagnostic Accuracy of Cell Block and Immunohistochemistry in Effusion Cytology

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