Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham NG5 1PB, UK.
J Clin Pathol. 2013 Jun;66(6):471-7. doi: 10.1136/jclinpath-2012-201109. Epub 2013 Mar 13.
Most diagnoses in breast pathology can be made with H&E sections. Nevertheless immunohistochemistry plays a useful supplementary role. This article reviews the common uses of immunohistochemistry in diagnostic breast pathology. It is important to be aware of the limitations of individual antibodies. Such problems can often be overcome by using panels of antibodies. Quality control is also essential: internal and external controls should show appropriate staining. Immunohistochemistry must be interpreted in combination with the morphology seen on H&E sections. Myoepithelial markers, such as smooth muscle actin, smooth muscle myosin heavy chain and p63, are useful for distinguishing invasive carcinoma from sclerosing lesions and ductal carcinoma in situ (DCIS), and in the classification of papillary lesions. Basal cytokeratins can help distinguish epithelial hyperplasia of usual type (UEH) and clonal proliferations such as DCIS and lobular carcinoma in situ (LCIS). UEH usually shows patchy expression whereas DCIS and other clonal proliferations are typically negative. E-cadherin can usually separate DCIS and LCIS: DCIS typically shows membrane staining and most LCIS is negative. Cytokeratins can be used to detect small nodal metastases or subtle invasive carcinomas such as invasive lobular carcinomas. Immunohistochemistry plays a useful role in diagnosing spindle cell lesions such as a panel of cytokeratins to identify spindle cell carcinomas. Immunohistochemistry is helpful in recognising metastases to the breast. Different antibodies are useful for different tumours: WT1 for ovarian carcinoma; TTF1 for pulmonary adenocarcinoma; S100, melan-A and HMB45 for melanoma; and lymphoid markers for lymphoma.
大多数乳腺病理学诊断可通过 H&E 切片完成。然而，免疫组织化学起着有用的辅助作用。本文回顾了免疫组织化学在诊断性乳腺病理学中的常见应用。了解单个抗体的局限性很重要。此类问题通常可以通过使用抗体组合来解决。质量控制也至关重要：内部和外部对照应显示适当的染色。免疫组织化学必须与 H&E 切片上的形态学结合进行解释。肌上皮标志物，如平滑肌肌动蛋白、平滑肌肌球蛋白重链和 p63，可用于区分浸润性癌与硬化性病变和导管原位癌 (DCIS)，并有助于对乳头状病变进行分类。基底细胞角蛋白有助于区分普通型上皮增生 (UEH) 和克隆性增殖，如 DCIS 和小叶原位癌 (LCIS)。UEH 通常呈斑片状表达，而 DCIS 和其他克隆性增殖通常为阴性。E-钙黏蛋白通常可将 DCIS 和 LCIS 区分开来：DCIS 通常显示膜染色，而大多数 LCIS 为阴性。细胞角蛋白可用于检测小的淋巴结转移或微妙的浸润性癌，如浸润性小叶癌。免疫组织化学在诊断梭形细胞病变（如一组细胞角蛋白以识别梭形细胞癌）中起着有用的作用。免疫组织化学有助于识别乳腺癌转移。不同的抗体对不同的肿瘤有用：WT1 用于卵巢癌；TTF1 用于肺腺癌；S100、黑色素瘤-A 和 HMB45 用于黑色素瘤；以及用于淋巴瘤的淋巴样标志物。
