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Diagnostic value of D2-40 immunostaining for malignant mesothelioma: a meta-analysis.

ABSTRACT: Malignant mesothelioma (MM) has become a global disease burden for its rising incidence and invariable fatality. D2-40 has been widely used as an immunostaining marker of diagnosing MM, while its diagnostic value has not yet been evaluated. Our study aimed to assess the overall accuracy of D2-40 immunostaining for diagnosing MM through a meta-analysis. A total of 22 studies with 2,264 participants were identified from PubMed, EMBASE, Web of Science, Scopus and the Cochrane database. The pooled sensitivity and specificity of D2-40 for MM was 0.86 (95% CI: 0.84-0.89) and 0.77 (95% CI: 0.74-0.79), respectively. The area under the summary receiver operating characteristic curve is 0.93, with a diagnostic odds ratio 40.37 (95% CI: 19.97-81.61). None of the study variates was found to be a source of heterogeneity after meta-regression analysis. In conclusion, D2-40 immunostaining may not give sufficient evidence by itself to diagnose MM and should be in combination with other markers to improve the accuracy of diagnosis.

SUBMITTER: He C

PROVIDER: S-EPMC5610012 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Diagnostic value of D2-40 immunostaining for malignant mesothelioma: a meta-analysis.

He Chao C Wang Bo B Wan Chun C Yang Ting T Shen Yongchun Y

Oncotarget 20170706 38

Malignant mesothelioma (MM) has become a global disease burden for its rising incidence and invariable fatality. D2-40 has been widely used as an immunostaining marker of diagnosing MM, while its diagnostic value has not yet been evaluated. Our study aimed to assess the overall accuracy of D2-40 immunostaining for diagnosing MM through a meta-analysis. A total of 22 studies with 2,264 participants were identified from PubMed, EMBASE, Web of Science, Scopus and the Cochrane database. The pooled s ...[more]

PMID: 28969080

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Project description:BACKGROUND:The classification of diffuse malignant mesothelioma into epithelioid, biphasic, and sarcomatoid types is based on histologic patterns. The diagnosis is made on biopsies, and because of intratumoral heterogeneity, they may not be representative of the entire tumor. The number and volume of biopsies needed to reach diagnostic accuracy in diffuse malignant mesothelioma and their prognostic value remain unclear. METHODS:This study examined 759 consecutive patients with pleural diffuse malignant mesothelioma treated by pleurectomy/decortication or extrapleural pneumonectomy for the presence of epithelioid and/or sarcomatoid histology and classified both the presurgery biopsies (core-needle or thoracoscopic) and surgical resection specimens. The number and volume of biopsies were correlated with pre- and postsurgery histologies and overall survival. RESULTS:Diffuse malignant mesothelioma was classified as epithelioid (76%), biphasic (18%), sarcomatoid (5%), or indeterminate (1%) in biopsies and as epithelioid (64%), biphasic (32%), and sarcomatoid (4%) in surgical resection specimens (overall concordance, 80.6%). The positive likelihood ratios were 2.4, 13.6, and 90.1 for biopsies with epithelioid, biphasic, and sarcomatoid histologies, respectively. Concordant histologies between biopsies and resections were associated with a higher number of biopsies (median tissue blocks for concordant histologies vs discordant histologies, 3 vs 2; P < .002) but were less associated with a higher volume (median, 1.2 vs 1.1 cm3 ; P = .06). In a multivariate analysis, overall survival was independently predicted by histology in the resection specimen (P < .0001) but not in the biopsy (P = .09). CONCLUSIONS:In contrast to epithelioid histology, sarcomatoid histology in biopsies is highly accurate. Despite intratumoral heterogeneity, the accuracy of histologic classification increases with the number of tissue blocks examined, emphasizing the diagnostic value of extensive sampling by presurgery biopsies.

Dataset Information

Diagnostic value of D2-40 immunostaining for malignant mesothelioma: a meta-analysis.

Publications

Diagnostic value of D2-40 immunostaining for malignant mesothelioma: a meta-analysis.

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