Bonacho T, Rodrigues F, Liberal J
Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal.
Qualidade de Vida no Mundo Rural (QRural), Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal.
Biotech Histochem. 2020 Feb;95(2):71-91. doi: 10.1080/10520295.2019.1651901. Epub 2019 Sep 10.
Breast cancer is the most prevalent malignant tumor and main oncologic cause of mortality in women. Although most diagnosis of breast pathology is accomplished using hematoxylin and eosin stained sections, some cases require immunohistochemistry for proper evaluation. We investigated the latter cases including distinctions between ductal and lobular carcinoma, in situ and invasive carcinoma, typical ductal hyperplasia and atypical ductal hyperplasia/ductal carcinoma in situ, papillary and spindle cell lesion assessment, metastasis evaluation, and assessment of prognostic and therapy markers. E-cadherin is used to differentiate ductal and lobular carcinoma; 34βE12, CK8, p120 catenin and β-catenin also produce consistent results. Myoepithelial cell (MEC) stains are used to evaluate in situ and invasive carcinoma; calponin, smooth muscle myosin heavy chain and p63 are sensitive/specific markers. 34βE12 and CK5/6 are positive in ductal hyperplasia, which enables its differentiation from atypical ductal hyperplasia and ductal carcinoma in situ. CK 5/6, ER and MEC markers are consistent options for evaluating papillary lesions. Spindle cell lesions can be assessed using β-catenin, SMA, CD34, p63, CKs and hormone receptors. It is important to differentiate primary carcinomas from metastases; the most commonly used markers to identify breast origin include mammaglobin, GCDFP-15, GATA3 and ER, although none of these is completely sensitive or specific. Immunohistochemistry can be used to evaluate central prognostic and predictive factors including molecular subtypes, HER2, hormone receptors, proliferation markers (Ki-67) and lymph-vascular invasion markers including ERG, CD31, CD34, factor VIII and podoplanin. Owing to the complexity of mammary lesions, diagnosis also depends on each particular situation, evaluation of cytological characteristics revealed by immunochemistry and correlation with histological findings.
乳腺癌是女性中最常见的恶性肿瘤和主要的肿瘤致死原因。尽管大多数乳腺病理诊断是通过苏木精和伊红染色切片完成的，但有些病例需要免疫组织化学检查才能进行准确评估。我们研究了这些病例，包括导管癌和小叶癌、原位癌和浸润癌、典型导管增生与非典型导管增生/导管原位癌之间的鉴别，乳头状和梭形细胞病变评估、转移评估以及预后和治疗标志物评估。E-钙黏蛋白用于区分导管癌和小叶癌；34βE12、细胞角蛋白8（CK8）、p120连环蛋白和β-连环蛋白也能产生一致的结果。肌上皮细胞（MEC）染色用于评估原位癌和浸润癌；钙调蛋白、平滑肌肌球蛋白重链和p63是敏感/特异的标志物。34βE12和CK5/6在导管增生中呈阳性，这有助于将其与非典型导管增生和导管原位癌区分开来。CK5/6、雌激素受体（ER）和MEC标志物是评估乳头状病变的一致选择。梭形细胞病变可使用β-连环蛋白、平滑肌肌动蛋白（SMA）、CD34、p63、细胞角蛋白和激素受体进行评估。区分原发性癌和转移癌很重要；用于确定乳腺来源的最常用标志物包括乳腺珠蛋白、GCDFP-15、GATA3和ER，尽管这些标志物都不完全敏感或特异。免疫组织化学可用于评估核心预后和预测因素，包括分子亚型、人表皮生长因子受体2（HER2）、激素受体、增殖标志物（Ki-67）以及包括ERG、CD31、CD34、因子VIII和足板蛋白在内的淋巴管浸润标志物。由于乳腺病变的复杂性，诊断还取决于每种具体情况、对免疫化学显示的细胞学特征的评估以及与组织学结果的相关性。
