The role of immunohistochemistry in the differential diagnosis of breast lesions
The role of immunohistochemistry in the differential diagnosis of breast lesions
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DOI：
10.1080/00313020802563544
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发表时间：
2009-01-01
期刊：
影响因子：
4.5
通讯作者：
Tan, Puay-Hoon
中科院分区：
文献类型：
--
作者：
Moriya, Takuya;Kozuka, Yuji;Tan, Puay-Hoon
免疫组织化学可能有助于各种乳腺病变的诊断。它可用于帮助区分良恶性疾病，或阐明浸润性癌的组织亚型。有几个标记相对频繁地被使用。肌上皮标志物(p63、α-SMA、平滑肌肌球蛋白重链等)有助于突出肌上皮细胞。它们被用来验证导管内乳头状病变中的肌上皮细胞衬里，或识别非浸润性癌的外周肌上皮细胞，尽管它们的染色结果并不总是很好。高分子细胞角蛋白(CK5/6、CK14、34βE12)在良性乳头状/增生性病变中呈典型的马赛克样表达，在导管原位癌中多数呈阴性表达，但也有少数例外。神经内分泌分化(由抗嗜铬粒素A或突触素证实)提示实性和乳头状导管内上皮细胞增殖为恶性。免疫组织化学评估顶分泌性病变的意义仍存在争议。E-钙粘附素染色阴性用于小叶癌的确诊性诊断，其特异性和敏感性约为90%。细胞角蛋白，尤其是抗体34βE12，对鉴别梭形细胞癌和叶状细胞癌有重要价值。还有一些其他有用的标记物来表征某些组织学亚型。然而，为了准确诊断，将免疫组织化学染色结果与组织学结果相关联是至关重要的。
Immunohistochemistry may be helpful in the diagnosis of various breast lesions. It can be used to assist in distinguishing benign and malignant conditions, or to clarify the histological subtype of invasive carcinomas. There are several markers relatively frequently utilised. Myoepithelial markers (p63, alpha-SMA, smooth muscle myosin heavy chain, and others) are useful to highlight myoepithelial cells. They are employed to verify myoepithelial cell lining in intraductal papillary lesions, or to recognise peripheral myoepithelial cells for non-invasive carcinoma, although their staining results are not always excellent. High molecular weight cytokeratins (CK5/6, CK14, 34 beta E12) typically show a mosaic-like pattern of expression in benign papillary/hyperplastic lesions, and are mostly negative in ductal in situ carcinoma, but some exceptions exist. Neuroendocrine differentiation ( confirmed by anti-chromogranin A or synaptophysin) suggests malignancy in solid and papillary intraductal epithelial proliferations. The significance of immunohistochemical evaluation of apocrine lesions is still controversial. Negative E-cadherin staining is used for making confirmative diagnosis of lobular carcinoma, with a specificity and sensitivity of approximately 90%. Cytokeratins, especially the antibody 34 beta E12, are of value to differentiate spindle cell carcinoma from phyllodes tumour. There are some other useful markers for characterising certain histological sub-types. Nevertheless, for accurate diagnosis, it is essential to correlate the immmunohistochemical staining results with the histological findings.