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6th ESACP Congress, Heidelberg, April 7-11, 1999 |
A106
Aims: 1. To identify the prevalence of immunohistochemical staining
of 12 different epithelial antibodies and DNA-aneuploidy in tumor cell positive
and negative effusions of the serous membranes. 2. To determine the positive
and negative predictive values (PPV, NPV) of BerEP4 staining and
DNA-aneuploidy detection in equivocal effusions for the occurrence of
tumor cells. Material and Methods: 1. 87 effusions unequivocally containing
carcinoma cells of different origins, 14 with malignant mesothelioma cells,
and 53 without tumor cells were investigated, applying a panel of 12
different epithelial antibodies and DNA-image-cytometry. 2. 65 effusions
with cytologically equivocal diagnoses suspicious for tumor cells were
investi gated with the same techniques. Clinical and/or histological
follow-ups were available for all patients.
Results: BerEP4 evolved as the diagnostically most useful antibody. Its
prevalence in effusions due to carcinoses was 95.4 %, 0 % in mesotheliomas
and in reactive mesothelial cells. Its PPV for the occurrence of cancer
cells in doubtful effusions was 100 %, its NPV 65.5 %. DNA-aneuploidy
occurred in 95.4 % of carcinoses, in 57.1 % in mesotheliomas, and in 0 % in
reactive effusions. Its PPV was 96.7 %, its NPV 72.0 % in doubtful effusions.
By combination of both markers the PPV for malignancy increased to 97.7 %,
the NPV for benignancy to 79.2 %. The differentiation between carcinoses
and mesotheliomas was correct in all cases using both adjuvant methods.
Discussion: The combined application of both adjuvant methods is able to
reduce the rate of equivocal cytological diagnoses in effusions by about
8 % identifying cancer cells which cannot be diagnosed by morphology alone.
Sensitivity of effusion cytology thus increases by about 8 %, specificity
by about 6 % as could be shown in a third study on the impact of these
adjuvant methods on diagnostic accuracy in a routine setting including
300 cases.
DNA-IMAGE-CYTOMETRY AND IMMUNOCYTOCHEMISTRY FOR IMPROVEMENT OF DIAGNOSTIC
ACCURACY IN EFFUSION CYTOLOGY
Motherby H, Kube M, Friedrichs N, Pomjanski N, Buckstegge B, Knops K,
Böcking A
Institute of Cytopathology, Heinrich-Heine-University, Düsseldorf, Germany