scholarly journals Differential Diagnosis of Epithelioid Malignant Mesothelioma With Lung and Breast Pleural Metastasis: A Systematic Review Compared With a Standardized Panel of Antibodies—A New Proposal That May Influence Pathologic Practice

2019 ◽  
Vol 144 (4) ◽  
pp. 446-456 ◽  
Author(s):  
Nolwenn Le Stang ◽  
Louise Burke ◽  
Gaetane Blaizot ◽  
Allen R. Gibbs ◽  
Pierre Lebailly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Differential Diagnosis ◽  
Malignant Mesothelioma ◽  
Estrogen Receptor Α ◽  
Routine Practice ◽  
Breast Cancers ◽  
Thyroid Transcription Factor 1 ◽  
Thyroid Transcription Factor ◽  
Pleural Metastasis ◽  
Transcription Factor 1

Context.— Pleural mesothelioma is a rare cancer with an often-challenging diagnosis because of its potential to be a great mimicker of many other tumors. Among them, primary lung and breast cancers are the 2 main causes of pleural metastasis. The development and application of targeted therapeutic agents have made it even more important to achieve an accurate diagnosis. In this setting, international guidelines have recommended the use of 2 positive and 2 negative immunohistochemical biomarkers. Objectives.— To define the most highly specific and sensitive minimum set of antibodies for routine practice to use for the separation of epithelioid malignant mesothelioma from lung and breast metastasis and to determine the most relevant expression cutoff. Design.— To provide information at different levels of expression of 16 mesothelial and epithelial biomarkers, we performed a systematic review of articles published between 1979 and 2017, and we compared those data to results from the Mesothelioma Telepathology Network (MESOPATH) of the standardized panel used in routine practice database since 1998. Results.— Our results indicate that the following panel of markers—calretinin (poly)/thyroid transcription factor 1 (TTF-1; clone 8G7G3/1) and calretinin (poly)/estrogen receptor-α (ER-α; clone EP1)—should be recommended; ultimately, based on the MESOPATH database, we highlight their relevance which are the most sensitive and specific panel useful to the differential diagnosis at 10% cutoff. Conclusions.— Highlighted by their relevance in the large cohort reported, we recommend 2 useful panels to the differential diagnosis at 10% cutoff.

Application of Immunohistochemistry to the Diagnosis of Malignant Mesothelioma

2008 ◽  
Vol 132 (3) ◽  
pp. 397-401 ◽  
Author(s):  
Alberto M. Marchevsky
Keyword(s):  
Differential Diagnosis ◽  
Malignant Mesothelioma ◽  
Data Sources ◽  
Evidence Based ◽  
Epithelial Markers ◽  
Thyroid Transcription Factor 1 ◽  
Thyroid Transcription Factor ◽  
Cytokeratin 5 ◽  
Transcription Factor 1 ◽  
Other Neoplasms

Abstract Context.—The diagnosis of malignant mesothelioma (MM) is rendered with the aid of immunohistochemistry to demonstrate the presence of “mesothelial,” “epithelial,” or “sarcomatous” differentiation. Antibody panels that have been proposed for the distinction between MM and other neoplasms usually include 2 or more epithelial markers used to exclude the diagnosis of a carcinoma, such as monoclonal and polyclonal carcinoembryonic antigen, Ber-EP4, B72.3, CD15, MOC-31, thyroid transcription factor 1, BG8, and others, and 2 or more mesothelial markers used to confirm the diagnosis of MM, such as cytokeratin 5/6, calretinin, HBME-1, thrombomodulin, WT-1, mesothelin, D2-40, and podoplanin. In general, most antibody panels provide excellent sensitivity and specificity for the differential diagnosis between MM epithelial variant and adenocarcinoma, particularly of lung origin. However, the accuracy of these markers is lower for the diagnosis of sarcomatous MM and for the differential diagnosis between MM and squamous cell carcinoma and carcinomas of renal, ovarian, and other origin. Objective.—To identify optimal antibody panels for the diagnosis of MM. Data Sources.—Literature review to determine how many and which mesothelial and epithelial markers need to be included in differential diagnosis antibody panels. Conclusions.—Various antibody panels have been recommended for the diagnosis of MM, with no overall consensus about how many and which markers should be used. A recent study with Bayesian statistics has demonstrated that the use of many markers does not provide higher diagnostic accuracy than the use of selected single antibodies or various combinations of only 2 markers. There is a need for the development of evidence-based or consensus-based guidelines for the diagnosis of MM in different differential diagnosis situations.

Application of Immunohistochemistry to the Diagnosis of Primary and Metastatic Carcinoma to the Lung

2008 ◽  
Vol 132 (3) ◽  
pp. 384-396 ◽  
Author(s):  
Jaishree Jagirdar
Keyword(s):  
Transcription Factor ◽  
Differential Diagnosis ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Lung Neoplasms ◽  
Small Cell ◽  
Immunohistochemical Markers ◽  
Thyroid Transcription Factor 1 ◽  
Thyroid Transcription Factor ◽  
Transcription Factor 1

Abstract Context.—Immunohistochemistry is a very valuable and often used tool in the differential diagnosis of lung carcinomas whether primary or secondary to the lung. The most useful application is in distinguishing primary lung tumors from metastatic tumors to the lung from common sites (colon, breast, prostate, pancreas, stomach, kidney, bladder, ovaries, and uterus). Immunohistochemistry also aids in the separation of small cell carcinoma from non–small cell carcinoma and carcinoids particularly in small biopsy specimens limited by artifact. Although there is no “lung-specific tumor marker,” with the help of a relatively restricted marker, thyroid transcription factor 1, it is possible to separate a lung primary from a metastasis with a reasonable degree of certainty. Another lung-specific marker on the horizon is napsin A, which appears to complement thyroid transcription factor 1 in defining a lung primary. Objective.—To present a practical review and to critique commonly used markers in the differential diagnosis of lung neoplasms and to list valuable immunohistochemical prognostic markers that the pathologist is called on to perform and interpret. Data Sources.—A comprehensive PubMed data search and personal practical experience. Conclusions.—With a panel of immunohistochemical markers, it is possible to distinguish or narrow down most lung neoplasms and separate them into meaningful therapeutic categories. In the future as more proteomic and genomic data surface, immunohistochemical markers to newly discovered antigens may become a routine part of prognostication.

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