Immunohistochemical differentiation between primary adenocarcinomas of theovary and ovarian metastases of colonic and breast origin. Comparison between a statistical and an intuitive approach
Jh. Lagendijk et al., Immunohistochemical differentiation between primary adenocarcinomas of theovary and ovarian metastases of colonic and breast origin. Comparison between a statistical and an intuitive approach, J CLIN PATH, 52(4), 1999, pp. 283-290
Citations number
34
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Aim-To discriminate between adenocarcinomas that are primary to the ovary a
nd metastatic to the ovary, especially of colonic and breast origin, by imm
unohistochemistry, using stepwise discriminant analysis or a decision tree.
Methods-312 routinely processed, formalin fixed tissue specimens were used.
The tumours were divided into a learning set (n = 159), composed of primar
y tumours of ovary, breast, and colon, and a test set, comprising 134 metas
tases from these sites and an additional 19 primary ovarian carcinomas. The
immunohistochemical panel was composed of antibodies against cytokeratin 7
(CK7) and 28 (CK20), CA125, vimentin, carcinoembryonic antigen (CEA), gros
s cystic disease fluid protein- 15 (GCDFP-15), and the oestrogen receptor (
ER). The staining results of the tumours were expressed as the product of t
he staining intensity and the percentage of positive tumour cells. Analyses
were first performed on the learning set and then evaluated on the test se
t.
Results-Although the immunostaining patterns showed a considerable overlap
between the three types of adenocarcinoma, the breast carcinomas were typic
ally positive for GCDFP-15 and often for ER, and negative for vimentin. Ova
rian carcinomas were always positive for CK7 and to a lesser extent for CR1
25. Colonic carcinomas showed prominent positivity for CEA and CK20, while
no staining was seen for ER and vimentin. In discriminant analysis, six ant
ibodies (alpha CK7, alpha CK20, alpha CA125, alpha CEA, alpha ER, and alpha
GCDFP-15) appeared to be necessary for optimal classification: 89% of the
learning set and 82% of the test set were classified correctly. In the deci
sion tree, only four antibodies (aCK7, alpha CEA, alpha ER, and alpha GCDFP
15) were used to obtain ri correct classification score of 89% for the lear
ning set and 84% for the test set.
Conclusions-Using a semiquantitative assessment of the immunostaining resul
ts by a restricted panel of six antibodies with stepwise discriminant analy
sis, 80-90% of the adenocarcinomas of colon, breast, and ovary can be corre
ctly classified. Discriminant analysis is computer aided and therefore an e
asy method and for each case a probability value of the classification resu
lt is obtained. The intuitive decision tree method provides a slightly bett
er result, requires only four antibodies, and offers a more practical metho
d for the surgical pathologist.