PRAME与p16联合免疫组化在黑素细胞肿瘤鉴别诊断中的应用，重点关注肢端病变
Combined immunohistochemistry of PRAME and p16 in the differentiation of melanocytic neoplasms, with a detailed focus on acral lesions.
作者信息
Zheng Jingwei, Zang Jie, Miao Qiuju, Shao Xuebao, Song Hao, Wang Xiaopo, Zhang Ying, Chen Hao
机构信息
Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China.
Department of Pathology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
出版信息
Diagn Pathol. 2024 Dec 27;19(1):167. doi: 10.1186/s13000-024-01586-y.
BACKGROUND
Isolated immunohistochemical indicators are limited to diagnose melanocytic neoplasms. This retrospective study is to assess the diagnostic value of combined immunohistochemical analysis targeting preferentially expressed antigen in melanoma (PRAME) and p16 in melanocytic neoplasms, with a detailed focus on arcal lesions.
METHODS
This was a single center cohort study from January 2022 to June 2023. A total of 165 identified cases were collected, including 112 melanomas (MMs) and 53 melanocytic nevi, which were composed of 122 acral samples and 43 non-acral samples. Immunohistochemistry(IHC) for both PRAME and p16 was performed in these cases, which was subsequently statistically analyzed to assess the diagnosis ability of PRAME and p16.
RESULTS
In total samples, the sensitivity and specificity of PRAME(+) for MM are 82.1% and 94.3% (AUC = 0.882, 95%CI:0.827-0.938), while of p16(-) for MM are 31.25% and 94.3% (AUC = 0.628, 95%CI:0.542-0.714); PRAME(+)/p16(-) (meaning as PRAME(+) or p16(-)) displayed a sensitivity and specificity of 85.7% and 88.7% for MM (AUC = 0.872, 95%CI:0.810-0.934), while PRAME(+) &p16(-) (meaning as PRAME(+) and p16(-)) revealed a sensitivity and specificity of 27.7% and 100% in MM (AUC = 0.638, 95%CI:0.555-0.722). In acral samples, PRAME(+)/p16(-) exhibited a specificity of 94.7% and a sensitivity of 86.9% for MM (AUC = 0.908, 95%CI: 0.849-0.968), with sensitivities of 90.9% for invasive MM and 82.5% for preinvasive MM, respectively; The sensitivity and specificity of PRAME(+) &p16(-) for MM is 22.6% and 100% (AUC = 0.613, 95%CI: 0.513-0.714) respectively. In non-acral samples, the sensitivity and specificity of PRAME(+)/p16(-) for MM are 82.1% and 73.3% (AUC = 0.777, 95%CI: 0.622-0.933), while of PRAME(+) &p16(-) are 42.9% and 100% (AUC = 0.714, 95%CI:0.564-0.864).
CONCLUSION
Combined IHC of PRAME and p16 contributes to discriminating melanocytic neoplasms, especially for in situ acral MM.
背景
孤立的免疫组化指标在诊断黑素细胞肿瘤方面存在局限性。本回顾性研究旨在评估针对黑色素瘤优先表达抗原（PRAME）和p16的联合免疫组化分析在黑素细胞肿瘤中的诊断价值，尤其着重于肢端病变。
方法
这是一项于2022年1月至2023年6月开展的单中心队列研究。共收集了165例确诊病例，包括112例黑色素瘤（MM）和53例黑素细胞痣，其中有122例肢端样本和43例非肢端样本。对这些病例进行了PRAME和p16的免疫组化（IHC）检测，随后进行统计学分析以评估PRAME和p16的诊断能力。
结果
在全部样本中，PRAME(+)对MM的敏感性和特异性分别为82.1%和94.3%（AUC = 0.882，95%CI：0.827 - 0.938），而p16(-)对MM的敏感性和特异性分别为31.25%和94.3%（AUC = 0.628，95%CI：0.542 - 0.714）；PRAME(+)/p16(-)（意为PRAME(+)或p16(-)）对MM的敏感性和特异性分别为85.7%和88.7%（AUC = 0.872，95%CI：0.810 - 0.934），而PRAME(+) &p16(-)（意为PRAME(+)且p16(-)）在MM中的敏感性和特异性分别为27.7%和100%（AUC = 0.638，95%CI：0.555 - 0.722）。在肢端样本中，PRAME(+)/p16(-)对MM的特异性为94.7%，敏感性为86.9%（AUC = 0.908，95%CI：0.849 - 0.968），侵袭性MM的敏感性为90.9%，原位前MM的敏感性为82.5%；PRAME(+) &p16(-)对MM的敏感性和特异性分别为22.6%和100%（AUC = 0.613，95%CI：0.513 - 0.714）。在非肢端样本中，PRAME(+)/p16(-)对MM的敏感性和特异性分别为82.1%和73.3%（AUC = 0.777，95%CI：0.622 - 0.933），而PRAME(+) &p16(-)的敏感性和特异性分别为42.9%和100%（AUC = 0.714，95%CI：0.564 - 0.864）。
结论
PRAME和p16的联合免疫组化有助于鉴别黑素细胞肿瘤，尤其是对于原位肢端MM。
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