Epithelial cell adhesion molecule (EpCAM) from pleural fluid cell lysates is a highly accurate diagnostic biomarker of adenocarcinomatous effusions. Issue 8 (22nd March 2019)

• Record Type: Journal Article
• Authors: Porcel, José M.; Esquerda, Aureli; Bielsa, Silvia; Novell, Anna; Sorolla, Maria Alba; Gatius, Sonia; Zamora, Carlos; Vidal, Silvia; Salud, Antonieta
• Is Part Of: Respirology. Volume 24:Issue 8(2019)
• Page Start: 799
• Page End: 804
• Publication Date: 2019-03-22
• Subjects: claudin 4 -- epithelial cell adhesion molecule -- human epididymis protein 4 -- pleural effusion; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13539
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: The discovery of highly accurate pleural fluid (PF) biomarkers of malignancy remains elusive. We assessed the operating characteristics of the PF epithelial cell adhesion molecule (EpCAM), claudin 4 (CL4) and human epididymis protein 4 (HE4) as potential markers of epithelial malignancies. Methods: The three markers were quantified by immunoassays in the supernatants (s) and cell lysates (cl) of 175 PF samples. The cut‐off values with 100% specificity were selected for malignant–benign discrimination. An immunocytochemical staining index score for each marker was also evaluated on PF cell blocks. The resulting best biomarker was further validated in two independent populations of 73 and 48 patients with pleural effusions (PE). Results: An EpCAM(cl) >98 pg/g total lysate protein yielded 75% sensitivity, 100% specificity, negative likelihood ratio of 0.25 and area under the curve of 0.94 for labelling adenocarcinomatous effusions. Sensitivity reached 88% if EpCAM(cl) was combined with EpCAM immunostaining. One‐third or more of the malignant effusions exhibiting a false‐negative cytological fluid examination were correctly classified by EpCAM(cl) concentrations. Immunoassays for CL4 and HE4 were diagnostically useless. Conclusion: EpCAM(cl) is a new biomarker of adenocarcinomatous PE with meaningful discriminating properties. Abstract : The epithelial cell adhesion molecule (EpCAM) is routinely integrated into different immunocytochemical panels to detect adenocarcinoma cases in effusion samples. This study shows that its quantification in pleural fluid cell lysates by using immunoassays outperforms classical immunostainings on cell blocks for identifying adenocarcinomatous effusions (respective areas under the curve of 0.94 and 0.87). Watch the video abstract