Abstract
BackgroundImmunohistochemistry using antibody cocktails against basal cell specific and cancer-associated markers is important in the diagnosis of prostate carcinoma in needle biopsies. We compared the usefulness for detecting prostate carcinoma of a three-marker cocktail of antibodies to α-methylacyl-CoA racemase (AMACR), p63 and cytokeratin (CK) 5 with a traditional two-marker cocktail of AMACR and p63.MethodsSixty-six prostate needle biopsies were analysed prospectively. Serial sections were immunostained with the two- and three- antibody cocktails. Blinded slides were assessed individually by two pathologists and sensitivity, specificity and kappa statistics were calculated.ResultsBoth antibody cocktails contributed to the detection of prostate carcinoma in needle biopsies. There was an acceptable level of agreement between the pathologists for both the cocktails. Sensitivity was similar for one pathologist comparing both the cocktails (76.4% and 75.7%), but was slightly lower comparing the three-antibody with the two-antibody cocktail for the other pathologist (66.6% vs. 77.4%, respectively). Higher specificity values of 90.3% were achieved by both pathologists using three-antibody as compared with two-antibody cocktails (68.7% and 71.8%).ConclusionsAntibody cocktails are important in diagnosing prostate carcinoma in needle biopsies. Adding an extra basal cell marker to the traditional two-antibody cocktail improves the specificity of detecting prostate carcinoma in limited needle biopsy material, and should be considered for routine diagnostic use.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2492231327330327
Highlights
Immunohistochemistry using antibody cocktails against basal cell specific and cancer-associated markers is important in the diagnosis of prostate carcinoma in needle biopsies
Immunohistochemistry Traditional two-marker cocktail Benign prostatic glandular tissue showed strong dark brown nuclear staining for p63 in basal cells without any cytoplasmic antibodies to α-methylacyl-CoA racemase (AMACR) staining in the glands [Figure 1]
Areas of prostatic intraepithelial neoplasia (PIN) showed both brown cytoplasmic granular AMACR staining in the luminal cells and dark brown nuclear (p63) and/or red cytoplasmic (CK 5) staining in partially preserved glandular basal epithelial cells [Figure 6]
Summary
Immunohistochemistry using antibody cocktails against basal cell specific and cancer-associated markers is important in the diagnosis of prostate carcinoma in needle biopsies. Histological diagnosis of prostatic cancer is usually based on histological evaluation of prostatic needle biopsies This can be challenging, when the malignant tissue is limited and is admixed with benign prostatic glands, or because of the presence of benign mimickers of malignancy such as atypical adenomatous hyperplasia (adenosis), atrophy, basal cell hyperplasia, nephrogenic adenoma, seminal vesicles or Cowpers glands [2,3,4]. In this setting, immunohistochemistry may contribute valuable differential diagnostic information and is used routinely in many pathology laboratories. Whilst a wide variety of immunohistochemical markers have been proposed for this purpose, antibodies against two classes of prostatic biomarkers are most commonly used; firstly, basal epithelial cell-specific markers and secondly, prostate carcinoma-specific markers
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