From the Department of Pathology, E. Couric Clinical Cancer Center, University of Virginia, Charlottesville (Gru).
The Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia (Lim).
Arch Pathol Lab Med. 2023 Jan 1;147(1):79-86. doi: 10.5858/arpa.2021-0270-OA.
CONTEXT.—: Although CD30 testing is an established tool in the diagnostic workup of lymphomas, it is also emerging as a predictive biomarker that informs treatment. The current definition of CD30 positivity by immunohistochemistry is descriptive and based on reactivity in lymphomas that are defined by their universal strong expression of CD30, rather than any established threshold. Challenges include inconsistencies with preanalytic variables, tissue processing, pathologist readout, and with the pathologist and oncologist interpretation of reported results.
OBJECTIVE.—: To develop and propose general best practice recommendations for reporting CD30 expression by immunohistochemistry in lymphoma biopsies to harmonize practices across institutions and facilitate assessment of its significance in clinical decision-making.
DESIGN.—: Following literature review and group discussion, the panel of 14 academic hematopathologists and 2 clinical/academic hematologists/oncologists divided into 3 working groups. Each working group was tasked with assessing CD30 testing by immunohistochemistry, CD30 expression readout, or CD30 expression interpretation.
RESULTS.—: Panel recommendations were reviewed and discussed. An online survey was conducted to confirm the consensus recommendations.
CONCLUSIONS.—: CD30 immunohistochemistry is required for all patients in whom classic Hodgkin lymphoma and any lymphoma within the spectrum of peripheral T-cell lymphoma are differential diagnostic considerations. The panel reinforced and summarized that immunohistochemistry is the preferred methodology and any degree of CD30 expression should be reported. For diagnostic purposes, the interpretation of CD30 expression should follow published guidelines. To inform therapeutic decisions, report estimated percent positive expression in tumor cells (or total cells where applicable) and record descriptively if nontumor cells are positive.
尽管 CD30 检测已成为淋巴瘤诊断工作中的一项既定工具，但它也正在成为一种预测性生物标志物，可以为治疗提供信息。目前，免疫组织化学检测 CD30 阳性的定义是描述性的，基于其普遍强烈表达 CD30 的淋巴瘤，而不是任何既定的阈值。挑战包括与分析前变量、组织处理、病理学家解读以及病理学家和肿瘤学家对报告结果的解读不一致。
制定并提出用于报告淋巴瘤活检中 CD30 免疫组织化学表达的一般最佳实践建议，以协调机构之间的实践，并促进评估其在临床决策中的意义。
在文献回顾和小组讨论之后，由 14 名学术血液病理学家和 2 名临床/学术血液科医生/肿瘤学家组成的小组分为 3 个工作组。每个工作组的任务是评估 CD30 免疫组织化学检测、CD30 表达解读或 CD30 表达解释。
小组建议进行了审查和讨论。进行了在线调查以确认共识建议。
所有需要考虑经典霍奇金淋巴瘤和外周 T 细胞淋巴瘤谱内任何淋巴瘤作为鉴别诊断的患者均需进行 CD30 免疫组织化学检测。专家组重申并总结，免疫组织化学是首选方法，应报告任何程度的 CD30 表达。出于诊断目的，CD30 表达的解读应遵循已发布的指南。为了告知治疗决策，报告肿瘤细胞中阳性表达的估计百分比（在适用的情况下为总细胞），并描述性地记录非肿瘤细胞是否阳性。
