Utility of GATA3, mammaglobin, GCDFP-15, and ER in the detection of intrathoracic metastatic breast carcinoma

Kathryn S Dyhdalo; Christine N Booth; Jennifer A Brainard; Maureen C Croyle; Ashley M Kolosiwsky; Abha Goyal; Thomas R Gildea; Francisco A Almeida; Aziza Nassar; Jordan P Reynolds

doi:10.1016/j.jasc.2015.01.008

Utility of GATA3, mammaglobin, GCDFP-15, and ER in the detection of intrathoracic metastatic breast carcinoma

J Am Soc Cytopathol. 2015 Jul-Aug;4(4):218-224. doi: 10.1016/j.jasc.2015.01.008. Epub 2015 Jan 29.

Affiliations

¹ Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio.
² Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
³ Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida.
⁴ Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio. Electronic address: Reynolj4@ccf.org.

PMID: 31051757
DOI: 10.1016/j.jasc.2015.01.008

Abstract

Introduction: Breast carcinoma (BC) metastatic to the intrathoracic cavity is difficult to diagnose due to low sensitivity of current immunohistochemical (IHC) stains. Mammaglobin, gross cystic disease fluid protein-15 (GCDFP-15), and estrogen receptor (ER) immunomarkers show variable results. GATA3 is a recently described marker for detecting urothelial and breast cancers. Our goal is to test the utility of GATA3 in cell blocks from thoracic cytology specimens.

Materials and methods: We retrieved cases of BC that metastasized to the thoracic cavity from January 1, 2005 to September 30, 2013. IHC was performed on the cell blocks for the presence of GATA3, ER, GCDFP-15, and mammaglobin. Stains were scored quantitatively and qualitatively.

Results: Fifty cases of metastatic BC found in pleural effusions and endobronchial ultrasound-guided fine-needle aspirates were identified in 48 patients. Thirty-four cases had sufficient material for IHC (19 pleural effusions, 15 endobronchial ultrasound-guided fine-needle aspirates). GATA3 showed strong nuclear positivity in 31 of 34 cases (91.2%). ER (25 of 34, 73.5%), mammaglobin (23 of 34, 67.6%) and GCDFP-15 (11 of 34, 32.6%) were positive in fewer cases. GATA3 and ER were concordant in 26 of 34 cases (76.5%) (24 ER/GATA3-positive, 2 ER/GATA3-negative). Discordant results were found in 8 of 34 cases (23.5%). Of these, GATA3 was positive and ER was negative in 7 cases. GATA3 was negative and ER was positive in 1 case.

Conclusions: GATA3 is more sensitive than ER, mammaglobin, or GCDFP-15 in detecting metastatic BC in cytologic specimens. GATA3 may be positive when ER is negative. In cytologic specimens with limited diagnostic material, GATA3 may be used as a first-line marker in a limited IHC panel to support metastatic BC.

Keywords: Breast cancer; Cytology; EBUS; Immunohistochemistry; Pleural effusion.