Immunohistochemistry utilization in the diagnosis of melanoma
Immunohistochemistry utilization in the diagnosis of melanoma
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DOI：
10.1111/cup.13648
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发表时间：
2020-05-01
影响因子：
1.7
通讯作者：
High, Whitney A.
中科院分区：
文献类型：
--
作者：
Dinehart, Matthew S.;Dinehart, Scott M.;High, Whitney A.
背景免疫组化（IHC）染色在皮肤病理学中的应用是很普遍的;然而，关于黑色素瘤诊断中的应用趋势知之甚少。目前的医疗保险当地覆盖范围确定（LCD）指出，大多数色素性病变，包括黑色素瘤，可以单独使用H&E进行诊断。方法2017年1月1日至2018年6月30日期间在一家皮肤科诊所切除的所有活检证实的黑色素瘤的组织学报告，采用以下参数进行识别：提供诊断的实验室/皮肤病理学家，是否进行了IHC，使用的染色剂的类型/数量，浸润的存在/深度，和黑色素瘤亚型。使用卡方（2）检验的分类变量进行评估的特点与IHC利用率的关联。在228例（64%）诊断中采用了IHC。侵袭性黑色素瘤199例（55.9%），原位黑色素瘤157例（44.1%）。在228例中，117例（58.8%）为侵袭性黑色素瘤，111例（70.7%）为MIS。关于IHC在黑色素瘤中的应用的现有LCD不能反映当前的实践状态。有必要进一步研究IHC的使用情况，并制定黑色素瘤IHC的适当使用标准。
Background The use of immunohistochemical (IHC) stains in dermatopathology is commonplace; however, little is known regarding utilization trends in melanoma diagnosis. Current Medicare local coverage determinations (LCDs) state that most pigmented lesions, including melanoma, can be diagnosed using H&E alone.Methods Histopathology reports for all biopsy-proven melanomas excised between January 1, 2017 and June 30, 2018, at a single dermatology clinic, were identified with the following parameters abstracted: laboratory/dermatopathologist rendering the diagnosis, whether IHC was performed, type/number of stains utilized, presence/depth of invasion, and melanoma subtype. The association of characteristics with IHC utilization was evaluated using chi(2) test for categorical variables.Results Three hundred and fifty six eligible melanomas were identified. IHC was employed in 228 (64%) of the diagnoses. Invasive melanoma was diagnosed in 199 cases (55.9%) while 157 (44.1%) were identified as melanoma in situ (MIS). Of the 228 that utilized IHC, 117 were performed on invasive melanoma (58.8%) and 111 were performed on MIS (70.7%).Conclusion Our findings suggest a higher IHC usage for the diagnosis of melanoma than previously reported. Existing LCDs regarding IHC utilization in melanoma do not reflect the current state of practice. Further investigation regarding IHC utilization and the development of appropriate-use criteria for melanoma IHC is necessary.