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Cost-effective screening using a two-antibody panel for detecting mismatch repair deficiency in sporadic colorectal cancer

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Abstract
BACKGROUNDThe microsatellite instability (MSI) test and immunohistochemistry (IHC) are widely used to screen DNA mismatch repair (MMR) deficiency in sporadic colorectal cancer (CRC). For IHC, a two-antibody panel of MLH1 and MSH2 or four-antibody panel of MLH1, MSH2, PMS2, and MSH6 are used. In general, MSI is known as a more accurate screening test than IHC.
AIMTo compare two- and four-antibody panels of IHC in terms of accuracy and cost benefit on the basis of MSI testing for detecting MMR deficiency.
METHODSWe retrospectively analyzed patients with CRC who underwent curative surgery between 2015 and 2017 at a tertiary referral center. Both IHC with four antibodies and MSI tests were routinely performed. The sensitivity and specificity of a four- and two types of two-antibody panels (PMS2/MSH6 and MLH1/MSH2) were compared on the basis of MSI testing for detecting MMR deficiency.
RESULTSHigh-frequency MSI was found in 5.5% (n = 193) of the patients (n = 3486). The sensitivities of the four- and two types of two-antibody panels were 97.4%, 92.2%, and 87.6%, respectively. The specificities of the three types of panels did not differ significantly (99.6% for the four-antibody and PMS2/MSH6 panels, 99.7% for the MLH1/MSH2 panel). Based on Cohen's kappa statistic (κ), four- and two-antibody panels were in almost perfect agreement with the MSI test (κ > 0.9). The costs of the MSI test and the four- and two-antibody panels of IHC were approximately $200, $160, and $80, respectively.
CONCLUSIONConsidering the cost of the four-antibody panel IHC compared to that of the two-antibody panel IHC, a two-antibody panel of PMS2/MSH6 might be the best choice in terms of balancing cost-effectiveness and accuracy.


Keywords: Adenocarcinoma, DNA mismatch repair, Immunochemistry, Monoclonal antibody, Microsatellite instability, Cost-effectiveness

Kim JB, Kim YI, Yoon YS, Kim J, Park SY, Lee JL, Kim CW, Park IJ, Lim SB, Yu CS, Kim JC.?Cost-effective screening using a two-antibody panel for detecting mismatch repair deficiency in sporadic colorectal cancer.?World J Clin Cases?2021;?9(24): 6999-7008 [DOI: 10.12998/wjcc.v9.i24.6999]
Author(s)
김종범김영일윤용식김지훈박서영이종률김찬욱박인자임석병유창식김진천
Issued Date
2021
Type
Article
Keyword
AdenocarcinomaDNA mismatch repairImmunochemistryMonoclonal antibodyMicrosatellite instabilityCost-effectiveness
DOI
10.12998/wjcc.v9.i24.6999
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8166
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2574741164&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Cost-effective%20screening%20using%20a%20two-antibody%20panel%20for%20detecting%20mismatch%20repair%20deficiency%20in%20sporadic%20colorectal%20cancer&offset=0&pcAvailability=true
Publisher
World Journal of Clinical Cases
Location
미국
Language
영어
ISSN
2307-8960
Citation Volume
9
Citation Number
24
Citation Start Page
6999
Citation End Page
7008
Appears in Collections:
Medicine > Medicine
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