Sensitivity and specificity of immunohistochemical antibodies used to distinguish between benign and malignant pleural disease: a systematic review of published reports

Abstract

Immunohistochemistry is of limited value, but newer diagnostic methods may be useful additions in this area of pathology. The diagnostic importance of histological features seen on plain tissue sections is emphasized as vital for correctly differentiating between benign pleural disease and malignant pleural mesothelioma.

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2012 Update of the Consensus Statement from the International Mesothelioma Interest Group

“…Before using an antibody for diagnosis, a laboratory should have carried out an extensive workup to find the ideal conditions for routine use. 4 The type of pathologic sample may affect results. For example, tiny needle biopsy samples may show crush artifact and false-positive immunostaining with various antibodies.…”

“…The most helpful of these include epithelial membrane antigen (EMA), p53, desmin, glucose transporter 1 (GLUT-1), and insulin-like growth factor II messenger RNA-binding protein 3 (IMP3), which can be applied as a panel. [3][4][5][6] When GLUT-1 staining is positive, it may be a helpful marker for MM, both epithelial and sarcomatoid ( Figure 3, A through D) but is not helpful when negative. It is more likely to be positive in pleural than in peritoneal MM.…”

Epithelioid Lesions of the Serosa

“…The most useful were desmin and EMA, with sensitivity and specificity above 74%. 61 The variation in marker sensitivity and specificity between different studies is remarkable, highlighting the importance of the laboratory's experience and reference materials.…”

“…The diffuse membranous expression of EMA is preferentially observed in neoplastic mesothelium, with a marker sensitivity and specificity of 58% to 100% and 45% to 100%, respectively. 54 King et al 61 performed a systematic review of the literature on the immunohistochemical markers of benign and malignant mesothelial cell proliferations, including p53, EMA, desmin, bcl-2, and p170. According to their analysis, most antibodies had poor to moderate diagnostic ability.…”

Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms

“…Epithelial membrane antigen (EMA) and p53 have been described as immunomarkers for malignancy, [82][83][84][85] whereas desmin has been described as an indicator of benign mesothelial cells. 84,85 A review by King et al 84 demonstrated sensitivity and specificity of desmin and EMA to be less than 90%, which may be deemed not sufficient enough when distinguishing benign from malignant.…”