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Utility of a CEA, CD15, Calretinin, and CK5/6 Panel for Distinguishing Between Mesotheliomas and Pulmonary Adenocarcinomas in Clinical Practice

Mohammad, Tareq MD*,†; Garratt, John RT*,†; Torlakovic, Emina MD‡,§; Gilks, Blake MD*,†; Churg, Andrew MD*,†

The American Journal of Surgical Pathology: October 2012 - Volume 36 - Issue 10 - p 1503–1508
doi: 10.1097/PAS.0b013e31825d5371
Original Articles

Most reports on antibodies that claimed to separate mesothelioma from pulmonary adenocarcinoma originated from academic centers or specialized immunohistochemistry laboratories, but little is known about how such stains perform in general practice laboratories. The Canadian Immunohistochemistry Quality Control program circulates tissue array slides to laboratories across Canada; these are stained and then interpreted by the local laboratory and by a set of experienced reviewers. For Canadian Immunohistochemistry Quality Control run 16, tissue array slides from 16 pulmonary adenocarcinomas and 6 mesotheliomas were stained in 36 different laboratories for CEA, CD15, CK5/6, and calretinin. A total of 736 results (cores) were interpretable. If 3 of 4 staining results concordant with the diagnosis was accepted as definitive, 166/192 (86.4%) mesothelioma cores and 461/544 (84.7%) adenocarcinoma cores were correctly diagnosed. However, if 4 of 4 concordant markers were required, then 93/192 (48.4%) mesothelioma cores and 265/544 (48.7%) adenocarcinoma cores were correctly diagnosed. Only 3/192 (1.6%) mesothelioma cores were incorrectly classified as carcinomas and 8/544 (1.5%) of adenocarcinoma cores incorrectly classified as mesotheliomas on the basis of the immunoprofile (ie, 3 of 4 or 4 of 4 marker results were discordant with the diagnosis). We conclude that, in a study based on results from nonspecialized laboratories, the combination of CEA, CD15, calretinin, and CK5/6, used as a panel, has a very low false-positive rate when separating pulmonary adenocarcinomas from mesotheliomas; however, single negative or incorrect results are common, therefore the panel is only useful diagnostically if 3 of 4 correct results are deemed acceptable for diagnosis.

*Department of Pathology, Vancouver General Hospital

Department of Pathology, University of British Columbia, Vancouver, BC

Department of Pathology, University Health Network

§Department of Pathology, University of Toronto, Toronto, ON, Canada

Conflicts of Interest and Source of Funding: Canadian Immunohistochemistry Quality Control (CIQC) is partly funded by the Canadian Partnership Against Cancer (CPAC). A.C. serves as a consultant to law firms in asbestos litigation. For the remaining authors none were declared.

Correspondence: Andrew Churg, MD, Department of Pathology, Vancouver General Hospital, 910 W 10th Ave., Room 1401,Vancouver, BC, Canada V5Z 4E3 (e-mail: achurg@mail.ubc.ca).

© 2012 Lippincott Williams & Wilkins, Inc.