Pathology Department, Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
Pathology Laboratory, Hasheminejad Kidney Center and Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.
Ann Diagn Pathol. 2014 Jun;18(3):163-70. doi: 10.1016/j.anndiagpath.2014.03.001. Epub 2014 Apr 1.
This study was performed on a series of prostate needle biopsies with diagnosis of atypical small acinar proliferation (ASAP) to verify to what extent the application of immunohistochemistry (IHC) for p504s and p63 markers as well as expert consultation by still images could affect the diagnosis. The results of these 2 methods were compared. Immunohistochemistry staining for p504s and p63 was performed on sections from 42 patients with a primary diagnosis of ASAP. Meanwhile, digital still images were taken from hematoxylin and eosin-stained slides of cases and were sent to an expert uropathologist, blind to IHC staining interpretations. The results of IHC staining were compared with diagnostic interpretations of the consultant pathologist. In 13 cases, the focus of concern was not detectable on IHC slides. In the remaining 29 cases, IHC showed a benign and malignant expression pattern in 17 and 9 patients, respectively. In 3 cases, IHC findings were inconclusive and retained the diagnosis of ASAP. The consultant pathologist diagnosed 11 cases of benign and 7 cases of malignant processes. He retained the diagnosis of ASAP in 11 cases. There was high concordance between the results of IHC and electronic consultation in the group of benign cases. All 11 cases with the diagnosis of benignancy by electronic consultation showed a benign IHC pattern. Among 7 cases with the diagnosis of malignancy by the consultant pathologist, 5 were classified as malignant, 1 as benign, and 1 as inconclusive IHC groups. Considering problems with IHC staining of prostate needle biopsy, including loss of focus of interest, expert consultation using still images can provide very useful diagnostic information. This approach can be used as an adjunct to other diagnostic activities like IHC or even as an independent source of information to reach more accurate diagnoses in ASAP cases, particularly in institutions with limited resources.
本研究对一系列诊断为非典型小腺泡增生 (ASAP) 的前列腺针吸活检进行了研究，以验证免疫组织化学 (IHC) 检测 p504s 和 p63 标志物以及通过静态图像进行专家咨询在多大程度上影响诊断。比较了这两种方法的结果。对 42 例原发性 ASAP 患者的切片进行了 p504s 和 p63 的免疫组织化学染色。同时，从病例的苏木精和伊红染色载玻片上拍摄数字静态图像，并发送给一位对 IHC 染色解释一无所知的泌尿科专家病理学家。将 IHC 染色结果与顾问病理学家的诊断解释进行比较。在 13 例中，无法在 IHC 载玻片上检测到关注点。在其余 29 例中，IHC 分别在 17 例和 9 例患者中显示良性和恶性表达模式。在 3 例中，IHC 结果不确定，保留 ASAP 的诊断。顾问病理学家诊断 11 例良性和 7 例恶性病例。他保留了 11 例 ASAP 的诊断。在良性病例组中，IHC 结果与电子咨询高度一致。电子咨询诊断为良性的 11 例均显示出良性 IHC 模式。在顾问病理学家诊断为恶性的 7 例中，5 例归类为恶性，1 例为良性，1 例为 IHC 组不确定。考虑到前列腺针吸活检的 IHC 染色存在问题，包括关注点丢失，使用静态图像的专家咨询可以提供非常有用的诊断信息。这种方法可以作为其他诊断活动（如 IHC）的辅助手段，甚至可以作为信息的独立来源，在 ASAP 病例中获得更准确的诊断，特别是在资源有限的机构中。
