Tracing the origin of adenocarcinomas with unknown primary using immunohistochemistry: Differential diagnosis between colonic and ovarian carcinomas as primary sites
- 1 May 1998
- journal article
- Published by Elsevier BV in Human Pathology
- Vol. 29 (5), 491-497
- https://doi.org/10.1016/s0046-8177(98)90065-x
Abstract
To discriminate adenocarcinoma metastases originating from either colon or ovary, a panel of immunohistochemical markers was evaluated. For this purpose, paraffin sections from 157 primary and metastatic colonic and ovarian carcinomas were immunostained. These cases were divided into a learning group of 46 colonic and 54 ovarian carcinomas and a test group of 29 colonic and 28 ovarian carcinomas, including all metastatic tumors, among which were five with unknown primary site at the time of testing. The sections were immunostained with antibodies against carcinoembryonic antigen (CFA), cytokeratin 7 (CK7), cytokeratin 20 (CK20), CA 125, vimentin, and CA 19.9. Staining results were expressed as the product of staining intensity and percentage of positive tumor cells. Stepwise discriminant analysis was applied on the learning set to obtain a classification function for both tumors. The validity of the classification function was evaluated using the test set. There was considerable overlap in immunostaining for both tumor types, but colonic carcinomas were typically positive for CEA and CK20 and negative for CK7 and CA125. Ovarian carcinomas were typically positive for CK7 and CA125 and negative for CEA and CK20. In discriminant analysis, the best combination of markers appeared to be CK7 and CFA. Only one sample of the test group (2%) was misclassified. Taking learning and test groups together, 136 of the 157 samples (87%) were correctly classified with high posterior probability (PP > .8). However, from the 28 mucinous ovarian carcinomas, only 19 (68%) could correctly be classified with high PP. When excluding the nonmnucinous ovarian carcinomas from the analysis, overall 87 of 103 (84.5%) of the samples were correctly classified (PP > .8) with a combination of CEA, CK7, and also vimentin. From the 28 mucinous ovarian carcinomas, only two (7%) were misclassified, and four could not be classified with sufficient certainty. In neither analysis did CK20, CA125, or CA19.9 emerge as discriminatory parameters. Based on the same data, an intuitive flow chart was constructed with which 129 of 157 cases could be classified (only one falsely) without further statistical analysis. The five metastases with an at first unknown primary could, according to the follow-up, all be classified correctly with high PP. Most ovarian carcinomas, including the mucinous ones, can be discriminated with high probability from colonic carcinomas using a panel of three antibodies directed against CEA, cytokeratin 7, and vimentin.Keywords
This publication has 12 references indexed in Scilit:
- Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovaryHuman Pathology, 1995
- Distribution of CA 19-9 in Adenocarcinomas and Transitional Cell Carcinomas: An Immunohistochemical Study of 527 CasesAmerican Journal of Clinical Pathology, 1993
- Distribution of CA 125 in Adenocarcinomas: An Immunohistochemical Study of 481 CasesAmerican Journal of Clinical Pathology, 1992
- Complexity of expression of intermediate filament proteins, including glial filament protein, in endometrial and ovarian adenocarcinomasHuman Pathology, 1991
- Differential Reactivities of Carcinoembryonic Antigen (CEA) and CEA-Related Monoclonal and Polyclonal Antibodies in Common Epithelial MalignanciesAmerican Journal of Clinical Pathology, 1990
- D-14 Monoclonal antibody to carcinoembryonic antigen: immunohistochemical analysis of formalin-fixed, paraffin-embedded human colorectal carcinoma, tumors of non-colorectal origin and normal tissuesZeitschrift für Krebsforschung und Klinische Onkologie, 1990
- Use of statistical evaluation of antigen profiles in differential diagnosis between colonic and ovarian adenocarcinomas.Journal of Clinical Pathology, 1988
- Coexpression of cytokeratins and vimentin in common epithelial tumours of the ovary: An immunocytochemical study of eighty-three casesVirchows Archiv, 1988
- Reactivity of a monoclonal antibody with human ovarian carcinoma.JCI Insight, 1981
- Colorectal carcinoma antigens detected by hybridoma antibodiesSomatic Cell and Molecular Genetics, 1979