Determination of optimal immunohistochemistry (IHC) panel for classification of esophageal tumours - A retrospective analysis and review of literature
Journal Title: Medpulse International Journal of Pathology - Year 2019, Vol 10, Issue 1
Abstract
Context: Histological classification of Esophageal tumors in small endoscopic biopsies based on morphologic criteria alone is difficult due to scant cellularity and biopsy artifacts, necessitating the use of ancillary techniques like IHC. Aims: To analyse the role of immunohistochemistry (IHC) in the classification of esophageal tumors with an optimal panel of markers (p63, Ck 5/6, CK-7, CDX2 and MUC5AC). Settings and Design: This was a retrospective study done at the Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally from January 2014 to October 2018. Material and Methods: Endoscopic biopsies from patients with 50 SCCs, 22 Adenocarcinomas and 25 poorly differentiated tumors were stained with IHC markers and their immunoreactivity was scored and documented. Statistical analysis used: Sensitivity, Specificity, Positive Predictive value (PPV), Negative Predictive value (NPV) and Accuracy of individual markers and their combination were calculated and documented. Results: In our study all cases of Squamous cell carcinoma were immunoreactive for p 63 and CK 5/6, with 4 + reactivity (in greater than 75% of tumor cells) observed in 48 cases (96%) for p63 and 46 cases (92%) for CK 5/6. The combination of p63 and cytokeratin 5/6 is highly sensitive, reasonably specific with high positive predictive and accuracy value for diagnosis of esophageal squamous cell carcinoma. In Esophageal adenocarcinomas strong immunoreactivity (3+,4+) for CK 7 was observed in 18 cases (81.8%), for MUC5AC in 17 cases (77.3%) and for CDX2 in 13 cases (59.1%). CK7(87.1%) was the most sensitive marker and MUC5AC had superior specificity (91.2%). Both markers in combination supplemented each other with improved attributes and formed a potent combination for securing a diagnosis of adenocarcinoma. Results of IHC on the subset of poorly differentiated carcinoma reflected same attributes as observed in individual markers/combination for squamous Cell Carcinoma and adenocarcinoma. Conclusions: First-line two marker panel of p63 and cytokeratin 5/6 is highly sensitive and specific for distinguishing squamous cell carcinoma from adenocarcinoma and in classification of poorly differentiated tumours. The presence of MUC5AC and CK 7 immunoreactivity may help establish the diagnosis of adenocarcinoma in the setting of negative/diminished/focal weak staining with p63 and cytokeratin 5/6
Authors and Affiliations
Srinivas DD Gubbala, Sridevi Mattaparti
Keywords
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- EP ID EP590585
- DOI 10.26611/1051012
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