Aksoy-Altinboga Aysegul, Baglan Tolga, Umudum Haldun, Ceyhan Koray
Division of Cytopathology, Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.
J Cytol. 2018 Oct-Dec;35(4):247-251. doi: 10.4103/JOC.JOC_18_17.
Differentiation between pancreatic ductal adenocarcinoma (PDAC) from benign mimickers is a well-known problem in cytological materials. Recent studies incorporated biological markers into this question and some studies showed that expression of S100P, IMP3, and maspin as well as nonexpression of von Hippel-Lindau gene product (pVHL) were significantly correlated with PDAC. In this study, we aimed to investigate diagnostic value of maspin, IMP3, S100P, and pVHL immunostaining in fine needle aspiration biopsies (FNABs) of pancreatic lesions.
In all, 33 cases of FNAB cell blocks of PDAC and 34 cases of surgical non-neoplastic pancreas specimens which were retrieved from the archives slides from 2007 to 2011 were included in this study. All the cases were stained with maspin, IMP3, S100P, and pVHL. Expression patterns of markers were scored and compared with benign mimickers. Test performance of each antibody and possible antibody combinations were also evaluated.
The study was composed of 33 PDAC and 34 control cases (8 chronic pancreatitis, 3 mucinous cystic neoplasm, and 23 nontumoral pancreatic tissue of PDAC). Diagnostic sensitivity for malignancy in S100P, IMP3, and maspin was 84.8%, 81.8%, and 87.5%, respectively. Specificity of these three markers was 100%. Sensitivity and specificity of pVHL for detecting nontumoral pancreatic tissue were 100% and 81.8%, respectively. When maspin, IMP3, and S100P expression were used together as triple test, sensitivity was 62.5% and specificity 100%. However, when any two of each three markers were evaluated (triple test/dual response), sensitivity reached 93.8% and specificity 100%.
We observed that dual response in triple test (positive staining with two of these three markers) of maspin, IMP3, and S100P immunocytochemistry is very sensitive and specific in differential diagnosis of PDA and non-neoplastic pancreatic lesions. pVHL may have an additional role, when triple assessment is not satisfactory.
在细胞学材料中，区分胰腺导管腺癌（PDAC）与良性模仿病变是一个众所周知的问题。最近的研究将生物标志物纳入了这个问题，一些研究表明，S100P、IMP3和maspin的表达以及von Hippel-Lindau基因产物（pVHL）的不表达与PDAC显著相关。在本研究中，我们旨在探讨maspin、IMP3、S100P和pVHL免疫染色在胰腺病变细针穿刺活检（FNAB）中的诊断价值。
本研究纳入了2007年至2011年存档玻片上的33例PDAC的FNAB细胞块和34例手术切除的非肿瘤性胰腺标本。所有病例均用maspin、IMP3、S100P和pVHL进行染色。对标志物的表达模式进行评分，并与良性模仿病变进行比较。还评估了每种抗体及可能的抗体组合的检测性能。
该研究由33例PDAC和34例对照病例组成（8例慢性胰腺炎、3例黏液性囊性肿瘤和23例PDAC的非肿瘤性胰腺组织）。S100P、IMP3和maspin对恶性肿瘤的诊断敏感性分别为84.8%、81.8%和87.5%。这三种标志物的特异性均为100%。pVHL检测非肿瘤性胰腺组织的敏感性和特异性分别为100%和81.8%。当将maspin、IMP3和S100P的表达一起用作三联检测时，敏感性为62.5%，特异性为100%。然而，当对这三种标志物中的任意两种进行评估（三联检测/双重反应）时，敏感性达到93.8%，特异性为100%。
我们观察到，maspin、IMP3和S100P免疫细胞化学三联检测中的双重反应（这三种标志物中的两种呈阳性染色）在PDA与非肿瘤性胰腺病变的鉴别诊断中非常敏感且特异。当三联评估不令人满意时，pVHL可能具有额外的作用。
