Prospective evaluation of AMACR (P504S) and basal cell markers in the assessment of routine prostate needle biopsy specimens
Prospective evaluation of AMACR (P504S) and basal cell markers in the assessment of routine prostate needle biopsy specimens
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DOI：
10.1016/j.humpath.2004.09.009
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发表时间：
2004-12-01
期刊：
影响因子：
3.3
通讯作者：
Rubin, MA
中科院分区：
文献类型：
--
作者：
Browne, TJ;Hirsch, MS;Rubin, MA
单纯根据前列腺芯针活检标本（PNB）的形态学区分良性前列腺和恶性前列腺可能很困难，特别是如果可疑病灶很小。近年来，几种免疫组织化学标记物，包括基底细胞混合物（BCC），34 β E12和p63，以及前列腺癌（PCa）生物标志物α-甲酰基-CoA-消旋酶（AMACR），已被用作形态学的佐剂，在这些诊断上具有挑战性的情况下。我们前瞻性地讨论了使用BCC与市售AMACR单克隆抗体P504 S组合对需要免疫组织化学（IHC）研究进行诊断的PNB的诊断效用。这项前瞻性研究的目的是评估学术环境中的日常实践，以确定这些IHC测试在常规PNTB上使用的频率，并确定BCC和P504 S的组合在诊断前列腺癌中的帮助频率。在7个月的时间内，共对772例前瞻性收集的PNB病例进行了检查。在171例（22%）中进行了IHC染色; 123例除市售单克隆AMACR抗体外，还使用BCC染色。在这123例病例中的86例（70%）中，两种染色均有助于最终诊断：PCa 44例，良性33例，高级别前列腺上皮内瘤变9例。在其余37例病例（30%）中，仅基于BCC的适当染色，18例被称为良性或PCa，AMACR无贡献，因为感兴趣的病灶已被切穿（12例），AMACR染色阴性（4例PCa病例），或AMACR染色阳性（2例良性病例显示萎缩）。37例中19例为不典型小腺泡增生。在这19个病例中，病灶在一个或两个污渍上都被切开了AMACR和BCC均不起作用者2例，1例BCC斑片状染色时AMACR阳性，3例BCC不染色时AMACR阴性，或尽管适当染色，但病灶由1个腺体组成，并且被认为太小而不能称为癌（2例）。772例中有171例进行了额外的HIC染色;其中123例有足够的材料进行BCC和P504 S。BCC与AMACR联合使用时，几乎70%的病例可作出诊断。联合使用这些染色剂可能是诊断困难病例的更好方法，因为它增加了明确诊断的可能性，同时降低了可疑诊断的可能性。然而，这种方法的局限性是这些小病变中的组织损失，这表明在单个载玻片上组合AMACR和BCC将上级单独使用任一标记物。(C)2004爱思唯尔公司All rights reserved.
Distinguishing benign prostate glands from malignant ones, based purely on morphology, on prostatic core needle biopsy specimens (PNBs) may prove difficult, particularly if the suspicious focus is small. In recent years, several immunohistochemical markers, including the basal cell cocktail (BCC), 34betaE12 and p63, and the prostate cancer (PCa) biomarker alpha-medlylacyl-CoA-racemase (AMACR), have been used as adjuvants to morphology, in these diagnostically challenging cases. We prospectively address the diagnostic utility of using the BCC, in combination with the commercially available AMACR monoclonal antibody, P504S, on PNBs that required immunohistochemistry (IHC) studies to make a diagnosis. The goals of this prospective study were to assess the day-to-day practice in an academic setting, to determine how often these IHC tests were used on routine PNTBs, and to establish how often a combination of the BCC and P504S were helpful in diagnosing prostate cancer. A total of 772 prospectively collected PNB cases were examined over a 7-month period. IHC staining was performed in 171 cases (22%); 123 cases were stained with the BCC in addition to the commercially available monoclonal AMACR antibody. In 86 of these 123 cases (70%), both stains contributed to the final diagnosis: PCa in 44 cases, benign in 33 cases and high-grade prostatic intraepithelial neoplasia in 9 cases. Of the remaining 37 cases (30%), 18 were called benign or PCa, based solely on appropriate staining with the BCC, with AMACR being noncontributory because the focus of interest had been cut through (12 cases), there was negative staining with AMACR (in 4 PCa cases), or there was positive staining with AMACR (in 2 benign cases showing atrophy). Nineteen of 37 cases were diagnosed as atypical small acinar proliferation. In these 19 cases either the focus had been cut through on one or both of the stains (11 cases), both AMACR and BCC failed to work (2 cases), AMACR was positive in the presence of patchy BCC staining (1 cases), AMACR was negative in the absence of BCC staining (3 cases), or despite appropriate staining the focus consisted of 1 gland and was considered too small to call carcinoma (2 cases). Additional HIC stains were performed in 171 of 772 cases; of these, 123 had sufficient material to perform both the BCC and P504S. The BCC when used in combination with AMACR rendered a diagnosis in almost 70% of cases. Using these stains in combination may be a better approach in diagnostically difficult cases as it increases the likelihood that a definitive diagnosis can be rendered while decreasing the likelihood of an equivocal diagnosis. However, a limitation of this approach is the loss of tissue in these small lesions, suggesting that combining AMACR and the BCC on a single slide would be superior to using either marker separately. (C) 2004 Elsevier Inc. All rights reserved.