Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Hum Pathol. 2019 Mar;85:128-135. doi: 10.1016/j.humpath.2018.10.035. Epub 2018 Nov 28.
Neuroendocrine tumors (NETs) are epithelial neoplasms with prominent neuroendocrine differentiation. Cytologic examination and utilization of immunohistochemical (IHC) markers are important diagnostic tools for the evaluation of these tumors. Herein we report our experience with the application of INSM1 in cytology samples. We searched our pathology system for cytologic specimens with INSM1 IHC performed from 2017 to 2018. Patients' demographics were recorded, and cytology materials were reviewed including all neuroendocrine IHC markers performed. A total of 134 (67 male, 67 female) specimens with INSM1 IHC were identified. Specimens included 91 (68.2%) NETs or tumors with neuroendocrine features (TNEFs), 33 (24.3%) nonneuroendocrine lesions (non-NET), and 10 (7.5%) nonneoplastic diagnoses. INSM1 was positive in 90 (99%) of the NET/TNEFs and negative in 32 (97%) non-NETs. CD56 was positive in 42 (95.5%) of the NET/TNEFs and negative on 9 (69.2%) of the non-NETs. The sensitivity of INSM1 was 99% and specificity was 97%, whereas the sensitivity of CD56 was 95.5% and specificity was 69.2%. Chromogranin had the lowest sensitivity (82.5%), and synaptophysin had the lowest specificity (66.7%). Both positive and negative predictive values of INSM1 were higher than CD56 (99% versus 91.3% and 97% versus 81.8%, respectively). INSM1 is a sensitive and specific marker for detection of NETs in cytology samples independent of primary site.
神经内分泌肿瘤（NETs）是具有突出神经内分泌分化的上皮性肿瘤。细胞学检查和免疫组织化学（IHC）标志物的应用是评估这些肿瘤的重要诊断工具。在此，我们报告了 INSM1 在细胞学样本中的应用经验。我们在我们的病理系统中搜索了 2017 年至 2018 年进行 INSM1 IHC 的细胞学标本。记录了患者的人口统计学信息，并回顾了细胞学材料，包括所有进行的神经内分泌 IHC 标志物。共确定了 134 例（67 名男性，67 名女性）进行 INSM1 IHC 的标本。标本包括 91 例（68.2%）NET 或具有神经内分泌特征的肿瘤（TNEF）、33 例（24.3%）非神经内分泌病变（非-NET）和 10 例（7.5%）非肿瘤性诊断。INSM1 在 90 例（99%）NET/TNEF 中为阳性，在 32 例（97%）非-NET 中为阴性。42 例（95.5%）NET/TNEF 中 CD56 阳性，9 例（69.2%）非-NET 中 CD56 阴性。INSM1 的灵敏度为 99%，特异性为 97%，而 CD56 的灵敏度为 95.5%，特异性为 69.2%。嗜铬粒蛋白的灵敏度最低（82.5%），突触素的特异性最低（66.7%）。INSM1 的阳性和阴性预测值均高于 CD56（99%对 91.3%，97%对 81.8%）。INSM1 是一种在细胞学样本中检测 NETs 的敏感且特异性标志物，与原发部位无关。
