title: Epstein-Barr virus (EBV)-encoded RNA: automated in-situ hybridization (ISH) compared with manual ISH and immunohistochemistry for detection of EBV in pediatric lymphoproliferative disorders.
abstract: Detection of Epstein-Barr virus (EBV) may be achieved by various methods, including EBV-encoded RNA (EBER) in-situ hybridization (ISH) and immunohistochemistry (IHC) for latent membrane protein (LMP-1). We compared novel automated ISH and IHC techniques in pediatric lymphoproliferative disorders with results obtained by manual ISH. Thirty-seven pediatric cases previously studied by manual EBER ISH (including 18 EBER-positive, 15 EBER-negative, and 4 EBER-equivocal cases) were used for the study. Automated EBER ISH and automated LMP-1 IHC were performed using the BondMax autostainer and prediluted EBER probe and EBV cell surface 1 to 4 at 1:50 dilution, respectively. Results of each of the automated techniques for EBV detection were compared with results by manual EBER ISH. Compared with manual EBER ISH as the gold standard, automated ISH had a sensitivity and specificity of 94% and 69%, respectively, accuracy of 83%, positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 90%. Automated IHC had a sensitivity of 44%, specificity of 93%, accuracy of 67%, PPV of 88%, and NPV of 59%. Automated ISH and IHC correlated significantly (P < 0.045). Automated ISH is useful for diagnosis of EBV-related pediatric neoplasms, being easy to perform and interpret and requiring only the technologist's time to set up and having a high sensitivity and NPV The automated IHC protocol is of too low sensitivity for routine use, although results show high specificity and PPV.
authors.affiliation: Emory University School of Medicine, Atlanta, GA 30322, USA. naimfanaian@gmail.com
authors.forename: Naim K
authors.initials: NK
authors.lastname: Fanaian
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cohen
authors.forename: Sandra
authors.initials: S
authors.lastname: Waldrop
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wang
authors.forename: Bahig M
authors.initials: BM
authors.lastname: Shehata
mesh_terms: D002648:Child; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000821:virology; D019309:Epstein-Barr Virus Nuclear Antigens / Q000235:genetics / Q000302:isolation & purification*; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics / Q000379:methods*; D017403:In Situ Hybridization / Q000191:economics / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000821:virology; D016377:Organ Transplantation / Q000009:adverse effects; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000302:isolation & purification / Q000378:metabolism; D015203:Reproducibility of Results; D014763:Viral Matrix Proteins / Q000235:genetics
chemical_list: C037662:EBV-associated membrane antigen, Epstein-Barr virus; D019309:Epstein-Barr Virus Nuclear Antigens; C099537:Epstein-Barr virus encoded RNA 1; D012367:RNA, Viral; D014763:Viral Matrix Proteins