Abstract
Numerous studies have investigated the utility of Ber-EP4 in differentiating metastatic adenocarcinoma (MAC) from malignant epithelial mesothelioma (MM) and/or reactive mesothelial cells (RM) in serous effusions. However, the results remain controversial. The aim of this study is to determine the overall accuracy of Ber-EP4 in serous effusions for MAC through a meta-analysis of published studies. Publications addressing the accuracy of Ber-EP4 in the diagnosis of MAC were selected from the Pubmed, Embase and Cochrane Library. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analysis was performed by Meta-Disc 1.4 and STATA 12.0 softwares. 29 studies, based on 2646 patients, met the inclusion criteria and the summary estimating for Ber-EP4 in the diagnosis of MAC were: sensitivity 0.8 (95% CI: 0.78–0.82), specificity 0.94 (95% CI: 0.93–0.96), positive likelihood ratio (PLR) 12.72 (95% CI: 8.66–18.7), negative likelihood ratio (NLR) 0.18 (95% CI: 0.12–0.26) and diagnostic odds ratio 95.05 (95% CI: 57.26–157.77). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.91; the area under the curve was 0.96. Our findings suggest that BER-EP4 may be a useful diagnostic adjunctive tool for confirming MAC in serous effusions.
Highlights
Distinguishing metastatic adenocarcinoma (MAC) from malignant mesothelioma (MM) and/or reactive mesothelial cells (RM) is very important for staging and has significant treatment implications
The following criteria were used in the selection of literature for meta-analysis: (1) studies evaluated Ber-EP4 in the differential diagnosis of MAC and MM/ RM in serous effusions, (2) each study contains more than ten fluid specimens, and (3) studies must provide sufficient data to calculate both sensitivity and specificity
Quality of reporting and study characteristics The article selection process used in this study is summarized in Overall, the 29 selected studies, which originated from 14 countries, included 2646 individuals and the sample size varied from 17 to 232 individuals with an average size of 90 individuals
Summary
Distinguishing metastatic adenocarcinoma (MAC) from malignant mesothelioma (MM) and/or reactive mesothelial cells (RM) is very important for staging and has significant treatment implications. Many tumor biomarkers directed against specific cell type antigens have been used in serous effusions to improve the accuracy of diagnosis, but the results are not always in agreement [7,8]. It remains unclear which marker has a superior performance and application of a novel panel of diagnostic markers for early and accurate detection of MAC is mandatory to aid conventional tests
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