From the Department of Pathology, University of California San Francisco, San Francisco (Dr Plourde); the Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and the Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (Dr Gross); and the Department of Pathology, University of Massachusetts Medical School, Worcester (Dr Jiang and Dr Owens).
Arch Pathol Lab Med. 2013 Nov;137(11):1630-4. doi: 10.5858/arpa.2012-0517-OA.
Immunohistochemical (IHC) stains have known utility in prostate biopsies and are widely used to augment routine staining in difficult cases. Patterns in IHC utilization and differences based on pathologist training and experience is understudied in the peer-reviewed literature.
To compare the rates of IHC usage between specialized (genitourinary; [GU]) and nonspecialized (non-GU) pathologists in extended core prostate biopsies (ECPBs) and the effects of diagnosis; and in cancer cases Gleason grade, disease extent, and perineural invasion on the rate.
Consecutive ECPBs from 2009-2011 were identified and billing data were used to determine the number of biopsies and IHC stains per case. Diagnoses were mapped and in cancer cases, Gleason grade, extent of disease, and perineural invasion were recorded. Pathologists were classified as GU or non-GU on the basis of training and experience.
A total of 618 ECPBs were included in the study. Genitourinary pathologists ordered significantly fewer IHC tests per case and per biopsy than non-GU pathologists. The rate of ordering was most disparate for biopsies of cancerous and benign lesions. For biopsies of cancerous lesions, high-grade cancer, bilateral disease, and perineural invasion decreased the rate of ordering in both groups. In cancer cases, GU pathologists ordered significantly fewer stain tests for highest Gleason grade of 3 + 3 = 6, for patients with focal disease and for patients with multiple positive bilateral cores. The effect of the various predictors on IHC ordering rates was similar in both groups.
Genitourinary pathologists ordered significantly fewer IHC stain tests than non-GU pathologists in ECPBs. Guidelines to define when IHC workup is necessary and not necessary may be helpful to guide workups.
免疫组织化学（IHC）染色在前列腺活检中有已知的用途，并且广泛用于在困难病例中增强常规染色。在同行评审文献中，关于 IHC 使用模式以及基于病理学家培训和经验的差异的研究较少。
比较专门的（泌尿生殖系统；[GU]）和非专门的（非-GU）病理学家在扩展核心前列腺活检（ECPBs）中使用 IHC 的比率，以及诊断的影响；以及在癌症病例中，Gleason 分级、疾病范围和神经周围侵犯对比率的影响。
确定了 2009-2011 年连续的 ECPB，并使用计费数据确定了每例活检和 IHC 染色的数量。对诊断进行了映射，在癌症病例中，记录了 Gleason 分级、疾病范围和神经周围侵犯。根据培训和经验，病理学家被分类为 GU 或非-GU。
共有 618 例 ECPB 纳入研究。泌尿生殖系统病理学家每例和每例活检的 IHC 检测数量明显少于非-GU 病理学家。订购率在癌性和良性病变的活检中差异最大。对于癌性病变的活检，高级别癌症、双侧疾病和神经周围侵犯降低了两组的订购率。在癌症病例中，GU 病理学家对最高 Gleason 分级 3+3=6、局灶性疾病和多个双侧阳性核心的患者的 IHC 染色测试数量明显减少。各种预测因子对 IHC 订购率的影响在两组中相似。
泌尿生殖系统病理学家在 ECPB 中比非-GU 病理学家订购的 IHC 染色测试明显减少。制定定义何时需要进行 IHC 检查以及何时不需要进行 IHC 检查的指南可能有助于指导检查。
