胰岛素瘤相关蛋白1是细胞学和手术标本中肺神经内分泌肿瘤的一种敏感且特异的标志物。
Insulinoma-associated protein 1 is a sensitive and specific marker for lung neuroendocrine tumors in cytologic and surgical specimens.
作者信息
Viswanathan Kartik, Siddiqui Momin T, Borczuk Alain C
机构信息
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York.
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York.
出版信息
J Am Soc Cytopathol. 2019 Nov-Dec;8(6):299-308. doi: 10.1016/j.jasc.2019.06.002. Epub 2019 Jun 26.
INTRODUCTION
Insulinoma-associated protein 1 (INSM1) is an immunohistochemical marker for neuroendocrine differentiation with potentially superior sensitivity and specificity. INSM1 performance in pulmonary cytology cell block material (CB) has not been well established, and large series demonstrating its performance have been few.
MATERIALS AND METHODS
Typical and atypical carcinoid, small cell lung carcinoma, and large cell neuroendocrine carcinoma, squamous cell carcinoma, and adenocarcinoma CBs and 563 surgical specimens comprising 17 typical carcinoid, 14 atypical carcinoid, 8 small cell lung carcinoma, 10 large cell neuroendocrine carcinoma, 58 squamous cell carcinoma, 415 adenocarcinoma, and 17 large cell carcinoma cases and 24 other tumor types were immunostained with INSM1, CD56, synaptophysin, and chromogranin A.
RESULTS
The INSM1 sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 100%, 78.9%, and 99% in the CBs and 89.8%, 98.1%, 81.5%, and 99% in the surgical specimens, respectively, with 86.2% concordance. The sensitivity, specificity, positive predictive value, and negative predictive value for the other neuroendocrine markers were 97.4%, 93.3%, 97.4%, and 93.3% in the CBs and 93.9%, 93.6%, 58.2%, and 99.4% in the surgical specimens for CD56; 89.7%, 100%, 100%, and 75% in the CBs and 93.4%, 91.2%, 50.5%, and 99.4% in the surgical specimens for synaptophysin; 66.7%, 100%, 100%, and 53.6% in the CBs and 75.5%, 98.6%, 84.1%, and 97.7% in the surgical specimens for chromogranin A, respectively. Finally, INSM1, together with CD56, maximized the sensitivity to 100% with 93.3% specificity in the CBs.
CONCLUSIONS
The results from our study have further established the high sensitivity and specificity of INSM1 in the largest pulmonary cytologic and surgical cohorts to date. INSM1 either matched or outperformed the performance of existing neuroendocrine markers, and its combination with CD56 appeared to maximize test performance.
引言
胰岛素瘤相关蛋白1（INSM1）是一种用于神经内分泌分化的免疫组织化学标志物，其敏感性和特异性可能更高。INSM1在肺细胞学细胞块材料（CB）中的表现尚未得到充分证实，且很少有大型系列研究展示其性能。
材料与方法
典型和非典型类癌、小细胞肺癌、大细胞神经内分泌癌、鳞状细胞癌和腺癌的CB以及563份手术标本，包括17例典型类癌、14例非典型类癌、8例小细胞肺癌、10例大细胞神经内分泌癌、58例鳞状细胞癌、415例腺癌、17例大细胞癌病例以及24种其他肿瘤类型，用INSM1、CD56、突触素和嗜铬粒蛋白A进行免疫染色。
结果
在CB中，INSM1的敏感性、特异性、阳性预测值和阴性预测值分别为92.3%、100%、78.9%和99%；在手术标本中分别为89.8%、98.1%、81.5%和99%，一致性为86.2%。其他神经内分泌标志物的敏感性、特异性、阳性预测值和阴性预测值在CB中，CD56分别为97.4%、93.3%、97.4%和93.3%；在手术标本中分别为93.9%、93.6%、58.2%和99.4%；突触素在CB中分别为89.7%、100%、100%和75%，在手术标本中分别为93.4%、91.2%、50.5%和99.4%；嗜铬粒蛋白A在CB中分别为66.7%、100%、100%和53.6%，在手术标本中分别为75.5%、98.6%、84.1%和97.7%。最后，在CB中，INSM1与CD56联合使用时，敏感性提高到100%，特异性为93.3%。
结论
我们的研究结果进一步证实了INSM1在迄今为止最大的肺细胞学和手术队列中的高敏感性和特异性。INSM1的表现与现有神经内分泌标志物相当或更优，其与CD56联合使用似乎能使检测性能最大化。
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