Clinical and molecular validation of BAP1, MTAP, P53, and Merlin immunohistochemistry in diagnosis of pleural mesothelioma.

Clinical and molecular validation of BAP1, MTAP, P53, and Merlin immunohistochemistry in diagnosis of pleural mesothelioma.
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DOI:
10.1038/s41379-022-01081-z
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发表时间:
2022-10
期刊:
影响因子:
7.5
通讯作者:
Sholl, Lynette M.
Sholl, Lynette M.
中科院分区:
医学1区
文献类型:
--
作者:
Chapel, David B.;Hornick, Jason L.;Barlow, Julianne;Bueno, Raphael;Sholl, Lynette M.

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BAP1 和 MTAP 免疫染色在间皮瘤的诊断中发挥着重要作用,但需要额外的标记物来提高敏感性。我们通过混合捕获下一代测序 (NGS) 面板分析了 84 个胸膜间皮瘤(51 个上皮样瘤、27 个双相瘤、6 个肉瘤样瘤),包括完全覆盖 BAP1、MTAP、NF2 和 TP53 的编码和剪接区域,并将分子结果分别与 BAP1、MTAP、Merlin 和 p53 的诊断免疫染色相关联。五十七个反应性间皮增殖作为良性比较。 BAP1、MTAP 和 Merlin 蛋白表达缺失对间皮瘤的敏感性分别为 54%、46% 和 52%,特异性为 100%。 BAP1 + MTAP、BAP1 + Merlin 和 MTAP + Merlin 的二标记免疫组合对间皮瘤的敏感性为 79%、85% 和 71%,而 BAP1 + MTAP + Merlin 的三标记免疫组合的敏感性为 90%。仅在 6 个 (7%) 肿瘤中观察到弥漫性(突变型)p53 免疫染色,但代表了 2 例肿瘤中唯一的免疫组织化学异常。无效模式 p53 对恶性肿瘤没有特异性。 BAP1 + MTAP + Merlin + p53 的免疫组合对间皮瘤的敏感性为 93%,NGS 组合检测到 BAP1、MTAP、NF2 和/或 TP53 的致病性改变为 95%。通过免疫组织化学或 NGS 检测,84 个肿瘤中有 83 个(99%)显示出诊断改变。将 Merlin 添加到标准 BAP1 + MTAP 免疫组合可提高间皮瘤的敏感性,而不会牺牲特异性。完全覆盖 BAP1、CDKN2A/MTAP、TP53 和 NF2 的 p53 免疫组织化学和面板 NGS 可能有助于诊断具有挑战性的病例。
BAP1 and MTAP immunostains play an important role in diagnosis of mesothelioma, but additional markers are needed to increase sensitivity. We analyzed 84 pleural mesotheliomas (51 epithelioid, 27 biphasic, 6 sarcomatoid) by a hybrid-capture next-generation sequencing (NGS) panel including complete coverage of coding and splicing regions for BAP1, MTAP, NF2, and TP53 and correlated molecular findings with diagnostic immunostains for BAP1, MTAP, Merlin, and p53, respectively. Fifty-seven reactive mesothelial proliferations served as benign comparators. Loss of BAP1, MTAP, and Merlin protein expression were, respectively, 54%, 46%, and 52% sensitive and 100% specific for mesothelioma. Two-marker immunopanels of BAP1 + MTAP, BAP1 + Merlin, and MTAP + Merlin were 79%, 85%, and 71% sensitive for mesothelioma, while a three-marker immunopanel of BAP1 + MTAP + Merlin was 90% sensitive. Diffuse (mutant-pattern) p53 immunostaining was seen in only 6 (7%) tumors but represented the only immunohistochemical abnormality in 2 cases. Null-pattern p53 was not specific for malignancy. An immunopanel of BAP1 + MTAP + Merlin + p53 was 93% sensitive for mesothelioma, and panel NGS detected a pathogenic alteration in BAP1, MTAP, NF2, and/or TP53 in 95%. Together, 83 (99%) of 84 tumors showed a diagnostic alteration by either immunohistochemistry or panel NGS. Adding Merlin to the standard BAP1 + MTAP immunopanel increases sensitivity for mesothelioma without sacrificing specificity. p53 immunohistochemistry and panel NGS with complete coverage of BAP1, CDKN2A/MTAP, TP53, and NF2 may be useful in diagnostically challenging cases.
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