Amin Khalid, El-Rayes Dina, Snover Dale, Mettler Tetyana, Vogel Rachel I, Khalifa Mahmoud A
Department of Laboratory Medicine and Pathology, University of Minnesota, MN.
Appl Immunohistochem Mol Morphol. 2019 Jul;27(6):441-447. doi: 10.1097/PAI.0000000000000643.
Immunohistochemistry (IHC) is a well-established morphology adjunct enabling pathologists to make accurate diagnoses. Metastases to the liver is a common scenario where pathologists may rely heavily on IHC in their interpretation. We conducted this study to audit the patterns of IHC utilization in malignant liver biopsies in 3 practice types (academic, community, and expert) as an initial step toward developing best practice guidelines. A total of 1100 specimens were analyzed and the association between the availability of history of other malignancies and the practice type on IHC utilization was studied. Community pathologists were twice as likely to use IHC and to use more markers per case than academic pathologists or the expert pathologist. When history of another malignancy was available, pathologists were not only 1.5 times more likely to use IHC but they also used more markers per case. IHC was still deemed necessary to reach the diagnosis in 67% of cases with a given history of other malignancy. This study described several variables for consideration in our effort to develop IHC utilization guidelines and its results quantify the variance noted among practice types.
免疫组织化学（IHC）是一种成熟的形态学辅助手段，可使病理学家做出准确诊断。肝转移是一种常见情况，在此过程中病理学家在解读时可能严重依赖免疫组织化学。我们开展这项研究以审核3种执业类型（学术型、社区型和专家型）在恶性肝活检中免疫组织化学的使用模式，作为制定最佳实践指南的第一步。共分析了1100份标本，并研究了其他恶性肿瘤病史的可获得性与执业类型对免疫组织化学使用的关联。社区病理学家使用免疫组织化学的可能性是学术病理学家或专家病理学家的两倍，且每例使用的标记物更多。当有其他恶性肿瘤病史时，病理学家不仅使用免疫组织化学的可能性增加1.5倍，而且每例使用的标记物也更多。在67%有其他恶性肿瘤特定病史的病例中，免疫组织化学仍被认为是做出诊断所必需的。本研究描述了在我们制定免疫组织化学使用指南的过程中需要考虑的几个变量，其结果量化了不同执业类型之间的差异。
