Department of Pathology, Abant Izzet Baysal University, Medical Faculty, Bolu, Turkey.
Urol Oncol. 2011 Nov-Dec;29(6):614-23. doi: 10.1016/j.urolonc.2009.11.013. Epub 2010 Mar 2.
In this study, we aimed to investigate which basal cell marker should be used with α-methylacyl coenzyme A racemase (AMACR) to increase diagnostic accuracy in the diagnosis of prostate carcinoma.
A total of 98 cases of prostate biopsy, comprising 65 cases with prostate adenocarcinoma and 33 cases without adenocarcinoma, were included in this study. Prostate-specific antigen (PSA) serum levels before biopsies were obtained. The number of cores with malignant glands and Gleason scores for each case were determined. Paraffin sections were stained immunohistochemically with 34βE12, keratin 5/6, p63, bcl-2, and AMACR.
According to staining pattern, extensiveness, and intensity of basal cell markers in benign glands, 34βE12 gave the best results. As negative markers for prostate adenocarcinoma, the best markers were p63 and 34βE12. According to the AUC values in ROC curves for both extensiveness and intensity, the arrangement from the best to the worst was 34βE12, p63, bcl-2, and keratin 5/6. The 34βE12 had the best sensitivity and specificity values (95% and 98%, respectively). Staining extensiveness and intensity of keratin 5/6 in malignant glands, and those of bcl-2 in benign glands had statistically significant positive correlation with serum PSA levels. Even though AMACR is a negative marker for benignity, some of the benign glands also had positive immune reaction with AMACR. However, AMACR positivity was usually focal and weak. Nevertheless, intensively stained subjects were also present. No correlation was present between AMACR and basal cell markers.
As a result, we suggest that keratin 5/6 and bcl-2 should not be used to identify benign glands in prostate biopsy since they show high positivity in malignant glands and high negativity in benign glands. 34βE12 should be the first choice as a basal cell marker. p63 can be used together with 34βE12, but it may not give additional diagnostic information. When we evaluated the correlation of basal cell markers, we did not find any complementary staining results among basal cell markers. Our study showed that 34βE12 is the most appropriate negative marker to combine with AMACR as a positive marker for the diagnosis of prostate adenocarcinoma.
本研究旨在探讨在诊断前列腺癌时，应与哪种基底细胞标志物联合使用α-甲基酰基辅酶 A 消旋酶（AMACR）以提高诊断准确性。
本研究纳入了 98 例前列腺活检病例，其中 65 例为前列腺腺癌，33 例为非腺癌。在活检前获得了前列腺特异性抗原（PSA）的血清水平。确定了每个病例的恶性腺体核心数和 Gleason 评分。对石蜡切片进行 34βE12、角蛋白 5/6、p63、bcl-2 和 AMACR 的免疫组织化学染色。
根据良性腺体中基底细胞标志物的染色模式、广泛程度和强度，34βE12 的结果最佳。作为前列腺腺癌的阴性标志物，最佳标志物是 p63 和 34βE12。根据 ROC 曲线中广泛程度和强度的 AUC 值，从最佳到最差的排列顺序是 34βE12、p63、bcl-2 和角蛋白 5/6。34βE12 的敏感性和特异性值（95%和 98%）最佳。恶性腺体中角蛋白 5/6 的染色广泛程度和强度，以及良性腺体中 bcl-2 的染色与血清 PSA 水平呈统计学显著正相关。尽管 AMACR 是良性的阴性标志物，但一些良性腺体也对 AMACR 有阳性免疫反应。然而，AMACR 的阳性反应通常是局灶性和弱阳性。尽管如此，也存在强烈染色的病例。AMACR 与基底细胞标志物之间没有相关性。
因此，我们建议角蛋白 5/6 和 bcl-2 不应用于识别前列腺活检中的良性腺体，因为它们在恶性腺体中呈高阳性，在良性腺体中呈高阴性。34βE12 应作为首选的基底细胞标志物。p63 可以与 34βE12 一起使用，但它可能不会提供额外的诊断信息。当我们评估基底细胞标志物的相关性时，我们没有发现基底细胞标志物之间存在任何互补的染色结果。我们的研究表明，34βE12 是与 AMACR 联合作为诊断前列腺腺癌的阳性标志物最适合的阴性标志物。
