Desouki Mohamed Mokhtar, Chamberlain Benjamin K, Li Zaibo
Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Ann Diagn Pathol. 2015 Oct;19(5):296-300. doi: 10.1016/j.anndiagpath.2015.06.005. Epub 2015 Jun 11.
Use of specific immunohistochemistry (IHC) marker, singly or in panels, differs and is influenced by practice setting, individual experience beside other factors. This is a part 2 study where we surveyed the application of IHC in gynecologic (gyn) pathology. Our specific aim in this part was to identify what specific stains are preferentially used. A retrospective chart review on all cases accessioned to the gyn pathology specialty sign out service during a 1-year period was performed at two academic pathology departments. Outside referral and consult as well as gyn cytology cases were excluded from the study. The most commonly ordered markers in diagnostic gyn pathology in descending order of frequency were as follows: P16, ki-67, p53, estrogen receptor (ER), progesterone receptor (PR), and CK7. P16 was used mainly in establishing the diagnosis/grading of squamous intraepithelial lesions (SIL) and differentiating serous from endometrioid carcinomas (ECs). P53 was used particularly in the diagnosis of serous carcinomas and establishing the diagnosis of differentiated vulvar intraepithelial neoplasia. Positive p16 was documented in all high-grade SIL, endocervical carcinomas, and serous carcinomas. In contrast, p16 was negative in all benign, low-grade SIL, and ECs. ER and PR were used in panels with p16, p53, vimentin, and carcinoembryonic antigen to assign tumors to specific site, in differentiating EC from serous carcinomas and in establishing the diagnosis of endocervical adenocarcinomas. Immunohistochemistry was used in 4.7% and 8.7% of gyn surgical path cases at two institutions. P16, ki-67, and p53 were the most commonly used markers especially in grading SIL. This study documents the most commonly used IHC biomarkers at two tertiary care academic centers for defining benchmarks for IHC use.
单独或联合使用特定免疫组织化学（IHC）标志物存在差异，且会受到实践环境、个人经验等其他因素的影响。这是一项第2部分研究，我们调查了IHC在妇科病理学中的应用。本部分的具体目标是确定优先使用哪些特定染色剂。在两个学术病理科对1年内进入妇科病理专科签出服务的所有病例进行了回顾性图表审查。本研究排除了外部转诊和会诊病例以及妇科细胞学病例。诊断性妇科病理学中最常开具的标志物按频率从高到低依次为：P16、Ki-67、p53、雌激素受体（ER）、孕激素受体（PR）和CK7。P16主要用于鳞状上皮内病变（SIL）的诊断/分级以及浆液性癌与子宫内膜样癌（EC）的鉴别。p53特别用于浆液性癌的诊断以及分化型外阴上皮内瘤变的诊断。所有高级别SIL、宫颈管癌和浆液性癌中P16均呈阳性。相比之下，所有良性、低级别SIL和EC中P16均为阴性。ER和PR与P16、p53、波形蛋白和癌胚抗原联合使用，用于将肿瘤定位到特定部位、鉴别EC与浆液性癌以及诊断宫颈管腺癌。在两家机构的妇科手术病理病例中，免疫组织化学的使用率分别为4.7%和8.7%。P16、Ki-67和p53是最常用的标志物，尤其是在SIL分级中。本研究记录了两个三级医疗学术中心最常用的IHC生物标志物，以确定IHC使用的基准。
