Immunohistochemistry as a surrogate for molecular testing: a review.

Despite the myriad of genetic and epigenetic alterations in human neoplasms that seem to demand specific molecular probes for their identification and practical application to diagnostic pathology, immunohistochemistry (IHC) remains a vital component of laboratory testing in the emerging molecular era. The development and proper application of sensitive and specific antibodies raised against cryptic proteins only expressed in quantity after gene translocation, translocation-specific chimeric fusion peptides, and gene products overexpressed because of gene amplification demonstrate that IHC is a legitimate surrogate for traditional cytogenetic and in situ hybridization-based identification of chromosomal abnormalities, if not a viable molecular technique in its own right. Similarly, the detection of mutational events, through the reliable demonstration of protein loss, the identification of proteins overexpressed because of activating mutations, the specific visualization of mutant gene products, and the localization of splice variant gene products emphasizes the potential value of IHC as a surrogate for mutational analyses of genes important to both diagnosis and prediction of therapeutic response. In the latter setting IHC also provides a means of approximating gene expression profiles in the molecular classification and risk stratification of human neoplasms. For time being, the application of appropriately targeted sensitive and specific antibodies provides a cost-effective screening modality, if not replacement, for selected molecular techniques, but IHC will lose its value if the development of companion tests for emerging novel biomarkers does not keep pace with molecular techniques, particularly as the costs and time constraints of genomic sequencing diminish over time.