Lyda M H, Tetef M, Carter N H, Ikle D, Weiss L M, Arber D A
Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA.
Am J Surg Pathol. 2000 Dec;24(12):1593-9. doi: 10.1097/00000478-200012000-00002.
Some patients with breast cancer currently undergo bone marrow biopsy to make clinical decisions regarding therapy; however, lobular carcinoma can be difficult to detect in routine histologic sections. The authors reviewed retrospectively all available bone marrow biopsies from patients with lobular carcinoma diagnosed between January, 1, 1989, and September, 25, 1997, at the City of Hope National Medical Center to identify useful morphologic features and to determine the utility of pan-keratin immunohistochemical (IHC) staining. A total of 65 biopsies from 54 patients were reviewed. Thirteen of the 65 biopsies were classified initially as containing metastatic tumor based on histologic features alone. With the addition of keratin IHC, seven additional cases of metastatic disease were detected. Forty of the 54 patients received stem cell replacement or autologous bone marrow transplantation. Disease-free survival after high-dose chemotherapy with stem cell replacement or autologous bone marrow transplantation was stratified into three groups based on hematoxylin and eosin (H&E) staining and IHC results. Two-year disease-free survival was 33% for the H&E-/IHC+ group versus 90% for the H&E-/IHC- group (p = 0.005) among patients clinically free of disease at the time of stem cell replacement or autologous bone marrow transplantation. Two-year disease-free survival was 0% in the H&E+/IHC+ group (p = 0.04, compared with the H&E-/ IHC+ group). The authors conclude that routine morphologic examination without the aid of keratin IHC is unreliable in detecting clinically relevant metastatic lobular carcinoma in bone marrow biopsies. These findings suggest that pan-keratin immunostaining may be indicated on bone marrow biopsy specimens from lobular carcinoma patients if the biopsy appears histologically negative for metastatic tumor on H&E sections.
目前，一些乳腺癌患者会接受骨髓活检，以便做出有关治疗的临床决策；然而，小叶癌在常规组织学切片中可能难以检测到。作者回顾性分析了1989年1月1日至1997年9月25日期间在希望之城国家医疗中心确诊为小叶癌的患者的所有可用骨髓活检样本，以确定有用的形态学特征，并确定泛角蛋白免疫组化（IHC）染色的效用。共回顾了54例患者的65份活检样本。65份活检样本中，有13份最初仅根据组织学特征被分类为含有转移性肿瘤。加上角蛋白免疫组化检测后，又发现了7例转移性疾病病例。54例患者中有40例接受了干细胞置换或自体骨髓移植。根据苏木精和伊红（H&E）染色及免疫组化结果，将接受干细胞置换或自体骨髓移植的高剂量化疗后的无病生存期分为三组。在干细胞置换或自体骨髓移植时临床无病的患者中，H&E-/IHC+组的两年无病生存率为33%，而H&E-/IHC-组为90%（p = 0.005）。H&E+/IHC+组的两年无病生存率为0%（与H&E-/IHC+组相比，p = 0.04）。作者得出结论，在骨髓活检中，不借助角蛋白免疫组化的常规形态学检查在检测临床上相关的转移性小叶癌时不可靠。这些发现表明，如果小叶癌患者的骨髓活检样本在H&E切片上组织学检查显示转移性肿瘤为阴性，那么可能需要进行泛角蛋白免疫染色。
