Bosch Dustin E, Kilgore Mark R, Schmidt Rodney A, Swanson Paul E, Rendi Mara H, Chang Oliver H
*Department of Pathology, University of Washington Medical Center †Department of Pathology, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
Appl Immunohistochem Mol Morphol. 2017 Sep;25(8):543-547. doi: 10.1097/PAI.0000000000000555.
Proliferative index is a prognostic feature of invasive ductal carcinoma of the breast, and has more recently emerged as a predictor of ductal carcinoma in situ (DCIS) local recurrence and progression when used in combination with other predictive markers. Ki67 is the most commonly used immunohistochemical marker of proliferative index. However, high interobserver and interlaboratory variability has been reported, in part due to differences in staining methodologies, positivity thresholds, and approaches to quantification. Phosphohistone-H3 (pHH3) is a marker of mitotic activity that has emerged as a more reliable indicator of proliferation in other neoplasms. Quantification of proliferative index was compared in 48 cases of DCIS using Ki67 and pHH3 immunohistochemistry. A strong linear relationship between Ki67 and pHH3 quantification was observed (P<0.0001, R=0.75). Interobserver concordance was modestly higher for pHH3 than Ki67 proliferative indices. However, positive pHH3 staining was more dichotomous (either negative or uniformly positive) and specific for mitotic activity, and interpretation of pHH3 proliferative indices was significantly faster than that of Ki67. The strong correlation between pHH3 and Ki67 supports the use of this marker as a measure of proliferative activity in DCIS.
增殖指数是乳腺浸润性导管癌的一个预后特征，最近已成为原位导管癌（DCIS）局部复发和进展的预测指标，当与其他预测标志物联合使用时。Ki67是增殖指数最常用的免疫组化标志物。然而，已有报道称观察者间和实验室间存在高度变异性，部分原因是染色方法、阳性阈值和定量方法的差异。磷酸化组蛋白H3（pHH3）是有丝分裂活性的标志物，已成为其他肿瘤中更可靠的增殖指标。使用Ki67和pHH3免疫组化对48例DCIS病例的增殖指数进行了比较。观察到Ki67和pHH3定量之间存在强线性关系（P<0.0001，R=0.75）。pHH3的观察者间一致性略高于Ki67增殖指数。然而，pHH3阳性染色更具二分性（要么阴性要么均匀阳性）且对有丝分裂活性具有特异性，并且pHH3增殖指数的解读明显快于Ki67。pHH3和Ki67之间的强相关性支持将该标志物用作DCIS增殖活性的指标。
