Ber-EP4
The Ber-EP4 antibody was generated using a membrane-enriched fraction derived from the MDF-7 breast cancer cell line. It reacts with an epitope present on two glycoproteins (of 30 and 34 kD respectively)36.
Prolonged formalin fixation of more than 48 hours has been reported to lead to loss of antigenicity11, although others have not found this11.
Immunohistochemical expression
Present on all epithelial cells, except the superficial layers of squamous epithelium, hepatocytes and parietal cells.
Diagnostic utility
-
Differentiation of mesothelioma from adenocarcinoma. The percentage of mesotheliomas expressing Ber-EP4 varies rather widely. This is in part because some authors count any single cell immunoreactivity as constituting positivity, while others set a cut-off. Some regard only basolateral membrane staining as true positivity. For example, Carella recommends a cut off level of at least 2% of cells stained, as well as the restrictive definition of "lateral membrane staining"9. While Ber-EP4 stains a high proportion of pulmonary adenocarcinomas, the rate of positivity is lower in non-pulmonary adenocarcinomas, falling to 35-50% for renal cell carcinomas.
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adenocarcinoma
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mesothelioma
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Latza 199011
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40/49(various sites of origin)
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0/2
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Kuhlmann 199116 (study done on cell blocks prepared from serous fluid)
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18/20(various sites of origin)
|
3/20
|
Sheibani 19921
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72/83
|
1/115(all histological types)
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Gaffy 199212
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103/120(various sites of origin. staining was membranous; diffuse in 82 and focal in 21 cases)
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10/49(6/32 epithelioid and 4/17 biphasic: staining was restricted to the epithelioid areas and was generally focal; in one epithelioid case, there was positivity of the majority of tumour cells)
|
Moch 199317
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34/34(pulmonary adenocarcinomas)
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2/27(all histological types; staining was focal in 2 cases)
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Dejmek 199418
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28/42(various sites of origin)
|
14/93
|
Grove 199419
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16/19(various sites of origin)
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8/39(epithelioid or biphasic types)
|
Maguire 199420 (study done on cell blocks prepared from serous fluid)
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45/63(13/23 pulmonary adenocarcinomas and 32/40 variously from breast, gastrointestinal tract, ovary, endometrium, and kidney)
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2/44
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Shield 199421 (study done on cell blocks prepared from serous fluid)
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33/102(various sites of origin)
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0/6
|
Ascoli 199522 (study done on cell blocks prepared from serous fluid)
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145/152(various sites of origin)
|
0/33
|
Atanoos 199523
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7/20(renal cell carcinomas)
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1/20
|
Doglioni 199613
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22/22(these were pulmonary adenocarcinomas: all showed staining of more than 50% of cells.)
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2/20(two cases weakly positive.)
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Bailey 199624 (study done on cell blocks prepared from serous fluid)
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11/11(pulmonary adenocarcinomas: all showed intense membrane staining)
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0/5
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Kuenen-Boumeester 199625 (study done on cell blocks prepared from serous fluid)
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56/56(various sites of origin)
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7/8(variable membranous staining)
|
Bateman 19972
|
9/14(primary and secondary adenocarcinomas within lung and pleura.)
|
1/17
|
Dejmek 19973
|
28/43
|
14/110
|
Riera 19974
|
135/211(various sites of origin)
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0/57(all of epithelioid type)
|
Delahaye 199726 (study done on cell blocks prepared from serous fluid)
|
69/88(various sites of origin)
|
1/41
|
Ordonez 199727
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38/38(pulmonary adenocarcinomas)
|
9/50
|
Wilson 199728
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9/9(lung and ovarian carcinomas)
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4/21
|
Chenard-Neu 19985
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30/30(various sites of origin)
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4/28
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Leers 199814
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19/21(various sites of origin. 17 cases showing staining of >10% of cells, 2 cases showed staining of <10% of cells.)
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7/20( 4 cases showing staining of >10% of cells, 3 cases showed staining of <10% of cells.)
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Garcia-Prats 199829
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16/18(13/15 pulmonary and 3/3 extrapulmonary)
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1/40(0/26 epithelioid, 0/10 sarcomatoid, 1/4 biphasic)
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Ordonez 199830
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101/110(20/20 pulmonary adenocarcinomas {staining diffuse], 55/59 non-pulmonary adenocarcinomas [variable extent of staining] and 26/31 adenocarcinomas of unknown origin [variable extend of staining]: all were metastatic to pleura)
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18/70(all epithelial pleural mesotheliomas: restricted to a limited number of cells)
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Brockstedt 20006
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40/57
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19/119
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Dejmek 200031 (study done on cell blocks prepared from serous fluid)
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51/53(various sites of origin)
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6/36
|
Gonzalez-Lois 20017
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11/13(various sites of origin)
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6/44(6/34 epithelioid, 0/6 sarcomatoid, 0/1 mixed and 0/1 lymphohistiocytoid mesotheliomas)
|
Harper 20018
|
12/18
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5/112
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Carella 20019
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20/20(pulmonary adenocarcinomas)
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4/46
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Comin 200110
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22/23(in 17 cases, staining was >75% of cells, in 5 cases 50-75% of cells.)
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5/42(staining was always less than 25% of cells.)
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Davidson 200132 (study done on cell blocks prepared from serous fluid)
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94/98(various sites of origin)
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4/12
|
Miettinen 200133
|
not studied
|
3/30(3/23 epithelioid and 0/7 sarcomatoid mesotheliomas)
|
Abutaily 2002 15
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10/11
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2/9
|
Ordonez 200334
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50/50(all primary lung adenocarcinomas: 37 case >75% of cells stained, 13 cases 50-75% of cells, . Staining was both cytoplasmic and membranous. Well-differentiated cases tend to show preferential staining of the basolateral membrane with negativity of the apical membrane.)
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11/60(epithelioid mesotheliomas: in 9 cases 1-25% of cells stained, in 2 cases <1% of cells stained)
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Overall
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80% (1394/1750)
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12% (174/1445)
|
A systematic review of seventeen studies (consisting of 702 pulmonary adenocarcinomas and 899 epithelioid mesotheliomas) reported sensitivities and specificities of BerEP4 for pulmonary adenocarcinoma of 80% and 90%38.
References
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3 Dejmek, A., Brockstedt, U., Hjerpe, A. Optimization of a battery using nine immunocytochemical variables for distinguishing between epithelial mesothelioma and adenocarcinoma. Apmis 1997;105:889-94.
4 Riera, J. R. Astengo-Osuna, C. Longmate, J. A. Battifora, H. The immunohistochemical diagnostic panel for epithelial mesothelioma: a reevaluation after heat-induced epitope retrieval. Am J Surg Path 1997;21:1409-19.
5 Chenard-Neu, M. P., Kabou, A., Mechine, A., et al. [Immunohistochemistry in the differential diagnosis of mesothelioma and adenocarcinoma. Evaluation of 5 new antibodies and 6 traditional antibodies.] Ann Pathol 1998;18:460-5. [French]
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8 Roberts, F., C. M. Harper, et al. (2001). "Immunohistochemical analysis still has a limited role in the diagnosis of malignant mesothelioma. A study of thirteen antibodies." Am J Clin Pathol 116(2): 253-62. Initially published in abstract as Harper CM. Evaluation of a commercially available immunohistochemical diagnostic panel for malignant mesothelioma. J Pathol 2001:193(suppl):39A.
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13 Doglioni, C., Tos, A. P., Laurino, L., Iuzzolino, P., Chiarelli, C., Celio, M. R., Viale, G. Calretinin: a novel immunocytochemical marker for mesothelioma. Am J Surg Pathol 1996;20:1037-46.
14 Leers, M. P., Aarts, M. M., Theunissen, P. H. E-cadherin and calretinin: a useful combination of immunochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma. Histopathology 1998;32:209-216.
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24 Bailey, M. E., R. W. Brown, et al. (1996). "Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1." Acta Cytol 40(6): 1212-6.
25 Kuenen-Boumeester, V., P. van Loenen, et al. (1996). "Quality control of immunocytochemical staining of effusions using a standardized method of cell processing." Acta Cytol 40(3): 475-9.
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27 Ordonez, N. G. (1997). "The value of antibodies 44-3A6, SM3, HBME-1, and thrombomodulin in differentiating epithelial pleural mesothelioma from lung adenocarcinoma: a comparative study with other commonly used antibodies [see comments]." Am J Surg Pathol 21(12): 1399-408.
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33 Miettinen, M., J. Limon, et al. (2001). "Calretinin and other mesothelioma markers in synovial sarcoma: analysis of antigenic similarities and differences with malignant mesothelioma." Am J Surg Pathol 25(5): 610-7.
34 Ordonez, N. G. (2003). "The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma." Am J Surg Pathol 27(8): 1031-51.
35 Miettinen, M., J. Limon, et al. (2001). "Calretinin and other mesothelioma markers in synovial sarcoma: analysis of antigenic similarities and differences with malignant mesothelioma." Am J Surg Pathol 25(5): 610-7.
36 Ordonez, N. G. (1998). "Desmoplastic small round cell tumor: II: an ultrastructural and immunohistochemical study with emphasis on new immunohistochemical markers." Am J Surg Pathol 22(11): 1314-27.
37 Pan, C. C., P. C. Chen, et al. (2004). "The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 cases." Histopathology 45(5): 452-9.
38 King JE, Thatcher N, Pickering CA, et al. Sensitivity and specificity of immunohistochemical markers used in the diagnosis of epithelioid mesothelioma: a detailed systematic analysis using published data. Histopathology 2006; 48:223-32
39 Fan YS, Carr RA, Sanders DS, et al. Characteristic Ber-EP4 and EMA expression in sebaceoma is immunohistochemically distinct from basal cell carcinoma. Histopathology 2007; 51:80-6
This page last revised 12.8.2007.
©SMUHT/PW Bishop