Title:
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The use of immunocytochemical markers for the diagnosis of malignancy in serious effusions
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The cytological diagnosis of malignancy in serous
effusions, at the present time, depends upon the recognition by light microscopy of morphological differences
between stained malignant and non-malignant cells. Not
infrequently reactive mesothelial cells present morphological changes indistinguishable from those of the 'benignlooking' malignant cells thereby presenting the cytologist
with differential diagnostic problems. The distribution of the Epithelial Membrane Antigen
(EMA) and the Carcinoembryonic Antigen (CEA) on cells in
effusions has been examined to ascertain whether this
approach is of value in discriminating between malignant
and mesothelial cells. The markers were demonstrated by
an indirect immunoalkaline phosphatase staining technique
on smear preparations of cells from serous effusions
subsequently fixed in 95% ethanol. This research was
extended to include radioimmunoassay for CEA in serous
effusions. A third aspect of this thesis involved an
attempt to raise monoclonal antibodies to non-neoplastic
mesothelial cells.
Three hundred and nine routine serous effusion
specimens were stained for EMA. The immunocytochemical
results were correlated with the cytology of the specimens
and the clinical diagnoses. The pattern of EMA staining
was classified as weak or strong. Weak staining was present
on non-neoplastic mesothelial cells as well as on malignant
epithelial cells. Strong EMA staining was present on 63
of the 116 specimens reported as cytologically positive
for malignancy. In addition, malignant cells in five cytologically suspicious and three negative effusions from
patients with epithelial malignant disease were picked out
by strong EMA staining. However, in three cases strong
EMA staining was also observed in specimens from patients
without evidence of malignancy indicating that this method
may give rise to false-positive results.
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