Reflex Immunohistochemistry and Microsatellite Instability Testing of Colorectal Tumors for Lynch Syndrome Among US Cancer Programs and Follow-Up of Abnormal Results
Reflex Immunohistochemistry and Microsatellite Instability Testing of Colorectal Tumors for Lynch Syndrome Among US Cancer Programs and Follow-Up of Abnormal Results
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DOI：
10.1200/jco.2011.38.4719
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发表时间：
2012-04-01
影响因子：
45.3
通讯作者：
MacDonald, Deborah J.
中科院分区：
文献类型：
--
作者：
Beamer, Laura C.;Grant, Marcia L.;MacDonald, Deborah J.
目的MLH1、MSH2、MSH6和PMS2蛋白表达的免疫组织化学(IHC)和微卫星不稳定性(MSI)是筛查Lynch综合征(LS)的成熟工具。尽管许多癌症中心在确诊为结直肠癌后采用了这些工具作为反射LS筛查，但护理标准尚未建立，也没有正式的研究描述这种做法在美国的情况。这项研究的目的是描述在美国关于LS的IHC/MSI反射测试的流行做法以及随后对异常结果的随访。材料和方法在跨学科专家输入后，制定了12个项目的调查。邀请函、调查和在线调查选项被发送给每个癌症项目的联系人。改进的Dillman策略被用来最大化应答率。样本包括39个国家癌症研究所指定的综合癌症中心(NCI-CCCS)、50个随机选择的美国外科医生学院认可的社区医院综合癌症项目(COMPS)和50个社区医院癌症项目(CHCP)。71%的NCI-CCCS、36%的COMP和15%的CHCP对LS进行反射性IHC/MSI；48%的程序使用IHC，14%的程序使用MSI，38%的程序同时使用IHC和MSI。1个程序使用术前信息包，4个程序提供选择退出选项，所有程序都不需要书面同意。结论尽管大多数NCI-CCCS使用REFLEX IHC/MSI筛查LS，但这种做法并未被社区医院很好地采用。这些发现可能表明，从NCI-CCC到社区癌症项目的护理和传播标准正在形成。我们的发现还描述了一个重要的趋势，即筛查不再需要患者的书面同意。
PurposeImmunohistochemistry (IHC) for MLH1, MSH2, MSH6, and PMS2 protein expression and microsatellite instability (MSI) are well-established tools to screen for Lynch syndrome (LS). Although many cancer centers have adopted these tools as reflex LS screening after a colorectal cancer diagnosis, the standard of care has not been established, and no formal studies have described this practice in the United States. The purpose of this study was to describe prevalent practices regarding IHC/MSI reflex testing for LS in the United States and the subsequent follow-up of abnormal results. Materials andMethodsA 12-item survey was developed after interdisciplinary expert input. A letter of invitation, survey, and online-survey option were sent to a contact at each cancer program. A modified Dillman strategy was used to maximize the response rate. The sample included 39 National Cancer Institute-designated Comprehensive Cancer Centers (NCI-CCCs), 50 randomly selected American College of Surgeons-accredited Community Hospital Comprehensive Cancer Programs (COMPs), and 50 Community Hospital Cancer Programs (CHCPs).ResultsThe overall response rate was 50%. Seventy-one percent of NCI-CCCs, 36% of COMPs, and 15% of CHCPs were conducting reflex IHC/MSI for LS; 48% of the programs used IHC, 14% of the programs used MSI, and 38% of the programs used both IHC and MSI. One program used a presurgical information packet, four programs offered an opt-out option, and none of the programs required written consent.ConclusionAlthough most NCI-CCCs use reflex IHC/MSI to screen for LS, this practice is not well-adopted by community hospitals. These findings may indicate an emerging standard of care and diffusion from NCI-CCC to community cancer programs. Our findings also described an important trend away from requiring written patient consent for screening.