The diagnostic use of ERG in resolving an "atypical glands suspicious for cancer" diagnosis in prostate biopsies beyond that provided by basal cell and α-methylacyl-CoA-racemase markers
The diagnostic use of ERG in resolving an "atypical glands suspicious for cancer" diagnosis in prostate biopsies beyond that provided by basal cell and α-methylacyl-CoA-racemase markers
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DOI：
10.1016/j.humpath.2012.06.024
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发表时间：
2013-05-01
期刊：
影响因子：
3.3
通讯作者：
Zhou, Ming
中科院分区：
文献类型：
--
作者：
Shah, Raja B.;Tadros, Yousef;Zhou, Ming
ERG 的免疫组织化学 (IHC) 染色用作 TMPRSS2-ERG 基因融合的替代物，这是一种特定的分子事件，在类似于 50% 的前列腺癌 (PCas) 和类似于 20% 的与相邻 PCa 混合的高级前列腺上皮内瘤变 (HGPIN) 中观察到，显示出相同的基因融合。我们使用多重 ERG/α-甲基酰基辅酶 A 消旋酶 (AMACR)/高分子量细胞角蛋白/p63 IHC 研究了 84 个“疑似癌症的非典型腺体 (ATYP)”病例，以确定 ERG 在 AMACR 和基础标志物提供的范围之外有助于解决 ATYP 诊断的频率。分别对 3、30 和 51 例病例进行形态学和所有标志物检查后，最终诊断为良性、ATYP 和癌症。在 51 例癌症诊断中，ERG 和 AMACR 分别有 45% 和 94% 呈阳性。在 30 例非典型诊断中，ERG 和 AMACR 分别有 10% 和 67% 呈阳性。在 3 例良性诊断中，ERG 和 AMACR 均未呈阳性，其中 83% 呈阳性。三个 ERG 阳性非典型病例被归类为“HGPIN 伴相邻 ATYP”。 ERG 在 20% 的 PCas 的邻近非癌腺体中表达，而 AMACR 在 40% 的病例的所有诊断类别的非癌腺体中表达。 ERG 染色阳性有助于 28% 的病例建立 PCa 的初始 ATYP 诊断，否则根据 AMACR 和基础标记物的诊断仍将是 ATYP。排除 HGPIN 诊断的小非典型腺体中的 ERG 阳性有助于在一小部分其他 ATYP 病例中建立明确的癌症诊断。我们建议在评估困难的前列腺活检时明智地使用 ERG，最好作为多重 MC 的组成部分。 (C) 2013 Elsevier Inc. 保留所有权利。
Immunohistochemical (IHC) staining for ERG is used as a surrogate for TMPRSS2-ERG gene fusion, a specific molecular event seen in similar to 50% of prostate carcinomas (PCas) and similar to 20% of high-grade prostatic intraepithelial neoplasia (HGPIN) intermingled with adjacent PCa demonstrating identical gene fusions. We studied 84 "atypical glands suspicious for cancer (ATYP)" cases using multiplex ERG/alpha-methylacyl-CoA-racemase (AMACR)/high-molecular-weight cytokeratin/p63 IHC to determine how often ERG contributes to resolving an ATYP diagnosis beyond that provided by AMACR and basal markers. Final diagnoses of benign, ATYP, and cancer were rendered after review of morphology and all markers in 3, 30, and 51 cases, respectively. Of 51 cancer diagnoses, 45% and 94% were positive for ERG and AMACR, respectively. Of 30 atypical diagnoses, 10% and 67% were positive for ERG and AMACR, respectively. Of 3 benign diagnoses, none and 83% were positive for ERG and AMACR, respectively. Three ERG-positive atypical cases were classified as "HGPIN with adjacent ATYP." ERG was expressed in adjacent noncancer glands of 20% of PCas, whereas AMACR was expressed in noncancer glands in all diagnostic categories in 40% of cases. Positive ERG staining helped establish the initial ATYP diagnosis to PCa in 28% cases whose diagnoses would otherwise remain ATYP based on AMACR and basal markers. ERG positivity in small atypical glands where HGPIN diagnosis is excluded helps establish a definitive cancer diagnosis in a small proportion of additional ATYP cases. We recommend judicious use of ERG, preferably as a component of multiplex MC, in evaluation of difficult prostate biopsies. (C) 2013 Elsevier Inc. All rights reserved.