Early diagnosis of mesothelioma in serous effusions using AgNOR analysis.
OBJECTIVE
To compare the results of conventional cytology, DNA image cytometry, immunocytochemistry and argyrophilic nucleolar organizer region (AgNOR) analysis for the diagnosis of malignant cells in serous effusions.


METHODS
One hundred twenty effusions, 40 with carcinoses, 40 with malignant mesotheliomas and 40 without tumor cells on follow-up were studied by conventional cytology and three adjunctive methods.


RESULTS
Unequivocal tumor cells were detected in 92.5% of effusions due to carcinoses and in 45% due to mesotheliomas. Applying immunocytochemistry with BerEP-4 positivity and DNA image cytometry with aneuploidy as a marker revealed 100% of carcinoses and 71.7% of mesotheliomas. Applying the experimentally found thresholds of 2.5 AgNORs as "satellites" and 4.5 AgNORs as "satellites and clusters" together as mean values per nucleus resulted in a 95% correct rate of mesothelioma and 100% rate of carcinoma cell identification without false positive diagnoses.


CONCLUSIONS
AgNOR analysis may be a useful adjunct to other methods in the routine diagnosis of malignant serous effusions. It seems to be the most sensitive method in early cytologic diagnosis of mesotheliomas in effusions. Seventy-three percent of malignant mesotheliomas were diagnosed cytologically at first on effusions. Forty-seven percent of patients with malignant mesotheliomas were identified at the early tumor stage T1 N0 M0.
Pomjanski
N
N
Institute of Cytopathology, Heinrich Heine University, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
Motherby
H
H
Buckstegge
B
B
Knops
K
K
Rohn
B L
BL
Böcking
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000782:Aneuploidy; D001202:Ascitic Fluid / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003581:Cytodiagnosis / Q000379:methods*; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006801:Humans; D019044:Image Cytometry; D007150:Immunohistochemistry; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis*; D008875:Middle Aged; D009697:Nucleolus Organizer Region / Q000473:pathology; D010490:Pericardial Effusion / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000473:pathology*; D016622:Silver Staining
D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm