title: A fine decision tree consisted of CK5/6, IMP3 and TTF1 for cytological diagnosis among reactive mesothelial cells, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion.
abstract: The utility of combination with CK5/6, IMP3 and TTF1 to differentiate among reactive mesothelial cells (RMs), metastatic adenocarcinoma of lung (LAC) and non-lung (NLAC) origin was investigated by using immunocytochemistry (ICC) and conventional PCR (C-PCR) in pleural effusion. A total of 108 cell blocks (32 RMs, 51 LAC and 25 NLAC were evaluated by ICC for CK5/6, IMP3 and TTF1 protein expression. In addition, we further performed C-PCR for amplification of CK5/6, IMP3 and TTF1 DNA from 28 specimens (9 MAC and 7 RMs, 6 LAC and 6 NLAC) for molecular diagnosis. CK5/6 staining was observed in the majority of reactive specimens (78.1%) and was rare in adenocarcinoma cells (14.5%), whereas the opposite was true for IMP3 and TTF1. We found a high frequency of TTF1 positivity (76.5%) in LAC, but not in NLAC (4.0%); while there was no significant difference of IMP3 expression in LAC (88.2%) and NLAC (88.0%). The 487 bp DNA fragments of IMP3 was expected to be amplified in 6/9 of adenocarcinoma cases showed negative in ICC; and the 394 bp DNA fragments of CK5/6 was also expected to be amplified in 4/7 of RMs cases showed negative in ICC. Consistent with ICC results, there was significant difference of TTF1 expression in the LAC and NLAC compared with IMP3 expression. The combination with CK5/6, IMP3 and TTF1 immunostaining appears to be useful to improve the accuracy of cytological diagnoses between RMs, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion. In addition, C-PCR may act as a useful supplemental approach for ICC, especially negative cases in ICC for differential cytological diagnosis.
authors.affiliation: Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
authors.forename: Jinhai
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Southern Medical University Guangzhou, China.
authors.forename: Qingzhu
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Jian
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Southern Medical University Guangzhou, China.
authors.forename: Jianghuan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
authors.forename: Hongping
authors.initials: H
authors.lastname: Tang
authors.affiliation: Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Ge
authors.affiliation: Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Southern Medical University Guangzhou, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Zhao
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry* / Q000235:genetics / Q000556:secondary*; D000077192:Adenocarcinoma of Lung; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000235:genetics; D004268:DNA-Binding Proteins / Q000032:analysis* / Q000235:genetics; D003663:Decision Trees; D003937:Diagnosis, Differential; D004848:Epithelium / Q000737:chemistry* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D053555:Keratin-5 / Q000032:analysis* / Q000235:genetics; D053553:Keratin-6 / Q000032:analysis* / Q000235:genetics; D008175:Lung Neoplasms / Q000737:chemistry* / Q000235:genetics / Q000556:secondary*; D016066:Pleural Effusion, Malignant / Q000737:chemistry* / Q000473:pathology; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011379:Prognosis; D016601:RNA-Binding Proteins / Q000032:analysis* / Q000235:genetics; D014157:Transcription Factors
chemical_list: D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C498780:IGF2BP3 protein, human; C503940:KRT5 protein, human; D053555:Keratin-5; D053553:Keratin-6; D016601:RNA-Binding Proteins; C504003:TTF1 protein, human; D014157:Transcription Factors
keywords: CK5/6; IMP3; PCR; TTF1; adenocarcinoma; pleural effusion