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Diagnostic role of immunohistochemistry in the evaluation of breast pathology specimens.

免疫组化在乳腺病理标本评估中的作用

Zhao L,Yang X,Khan A,Kandil D

Abstract

Context.-Immunohistochemistry plays a vital role in the evaluation of breast pathology specimens. Objective.-To discuss the role of myoepithelial cell markers in the evaluation of various breast lesions. Other markers, such as E-cadherin and those used to differentiate mammary carcinoma from metastatic tumors to the breast, and markers used in the differential diagnosis of Paget disease, are also discussed. Data Sources.-Data were obtained from review of the pertinent peer-reviewed literature. Conclusions.-Myoepithelial cell markers vary in their sensitivity and specificity, and one should be aware of the potential pitfalls in interpretation. Using panels of 2 or more myoepithelial cell markers is always recommended, either singly or in cocktail forms. Although negative E-cadherin staining supports the diagnosis of lobular origin, positive staining does not rule it out. Immunohistochemistry can be helpful in differentiating Paget disease from its mimics. Although metastatic tumors to the breast are rare, a triple-negative immunophenotype and absence of an in situ component should be a "red flag" for such possibility, especially in patients with clinical history of an extramammary malignancy.

摘要

背景—免疫组化在乳腺病理标本的评估中起着非常重要的作用。 目的—探讨肌上皮细胞在在各类乳腺疾病评估中的作用,并讨论其他标记如E-cadherin、以及用于鉴别乳腺原发肿瘤和转移性肿瘤的标记物、用于Paget病鉴别诊断的标记物。数据来源—通过回顾分析以往相关的同行评审文献。结论—肌上皮标记的敏感性和特异性变化较大,解读时一定要警惕潜在的诊断陷阱。无论是单独或者以鸡尾酒形式时,推荐联合应用2个或2个以上的肌上皮标记。尽管E-cadherin阴性提示小叶源性肿瘤的诊断,但阳性时不能排除小叶源性。免疫组化在Paget并及其类似疾病的鉴别中很有帮助。尽管乳腺的转移癌少见,免疫标记三阴性和缺乏原位成分时提示有转移癌的可能,尤其是在临床上有其他非乳腺恶性肿瘤病史的患者。

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