Ema-and useful immunocytochemical marker at differentiation of glandular malignant cells from atypical mesothelial cells on cell block preparation of body effusions

Neha Jaiswal*, Arvind Bhake, Anita Sajjanar

Jawaharlal Nehru Medical College, Sawangi, Maharashtra, India

ABSTRACT

The detection of the malignant cells by cytologic method has long been practised. The detected malignant cells are difficult to be typed specially in the situations of overlapping cytomorphology. The conventional cytologic preparation may harbour lower number of malignant cells but the method of cell block offers high detection rates of such malignant cells. Still the problem remains when the evaluation is short by morphological features and requires immunoexpression studies. The commonest situation encountered of overlap cytomorphology is the distinction between well differentiated adenocarcinoma from reactive mesothelial cells with atypia in effusion. Such a distinction is not only important for the purposes of diagnosis but also for prognostification by stage and management of the patient .The review presents the experiences of the past studies over utility of EMA in detection and segregation of the cells of well differentiated adenocarcinoma infiltrating the effusions from reactive atypical mesothelial cells. The present review is compiled from the publications from various institute across the globe and shares the authors experience for the utility of epithelial membrane antigen over the cell block of effusions at distinction of overlap cytomorphology. Compilation of the study by inclusion of articles by 1,2,3,3,4,5,6,7,8,9,10.The articles were searched through google engine and Pubmed search. The 10 articles dealing onto the role of EMA as a immunocytochemical marker have affirmed the high sensitivity and specificity of EMA at seggregating glandular malignant cells from atypical mesothelial cells on cell block preparation of body effusions.The range of sensitivity and specificity for EMA was found to be 81% -100% and 98.86 -100% respectively.The positive predictive value range from 92-97% and negative predictive value ranging from 88.64 – 100%. All the studies reviewed confirmed the high value of significance (P value for EMA). The systematic review carried out re-affirms the role of EMA in the situations of of indistinguishable cytomorphology of adenocarcinoma from that of benign , reactive , atypical mesothelial cells. The overall diagnostic utility of EMA was conducted to br over 90% in such situations.

Keywords:

EMA, Immunocytochemistry, Adenocarcinoma, Mesothelial cells, Cellblock, Effusions