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BAP1 Immunohistochemistry and p16 FISH to Separate Benign From Malignant Mesothelial Proliferations.

​联合BAP1 IHC/P16 FISH 检测,用以鉴别良恶性间皮细胞增生

Sheffield BS,Hwang HC,Lee AF,Thompson K,Rodriguez S,Tse CH,Gown AM,Churg A

Abstract

A variety of immunohistochemical (IHC) stains have been proposed to mark either benign or malignant mesothelial proliferations. Loss of the p16 tumor suppressor (CDKN2A), through homozygous deletions of 9p21, is a good marker of mesotheliomas but lacks sensitivity. Recent reports indicate that some mesotheliomas are associated with loss of BRCA-associated protein 1 (BAP1) expression. Here we investigate BAP1 and p16 as potential markers of malignancy and compare test characteristics with previously proposed markers using a well-characterized tissue microarray. BAP1 protein expression was interrogated by IHC. The p16 locus was examined by fluorescence in situ hybridization (FISH) directed toward chromosome 9p21. Loss of BAP1 was identified in 7/26 mesotheliomas and 0/49 benign proliferations. Loss of p16 was identified in 14/27 mesotheliomas and 0/40 benign proliferations, yielding 100% specificity and positive predictive value for each marker. Together, BAP1 IHC and p16 FISH were 58% sensitive for detecting malignancy. Various combinations of p53, EMA, IMP3, and GLUT1 showed reasonably high specificity (96% to 98%) but poor to extremely poor sensitivity. Combined BAP1 IHC/p16 FISH testing is a highly specific method of diagnosing malignant mesotheliomas when the question is whether a mesothelial proliferation is benign or malignant and is particularly useful when tissue invasion by mesothelial cells cannot be demonstrated. However, combined BAP1/p16 FISH testing is not highly sensitive, and negative results do not rule out a mesothelioma. The test characteristics of previously proposed markers EMA, p53, GLUT1, IMP3 suggest that, even in combination, these markers are not useful tools in this clinical setting.

摘要

摘要

目前已经提出应用多种抗体免疫组化染色来区分良性或恶性间皮细胞增生。染色体9p21纯合性缺失而使p16抑癌基因(CDKN2A)不表达是间皮瘤一个很好的标记,但缺乏敏感性。最近研究显示,一些间皮瘤与BRCA相关蛋白1(BAP1)表达丢失有关。本文应用特征性组织芯片技术,研究BAP1和p16作为恶性间皮细胞标记的潜能,并与其它标记做对比。用IHC方法检测BAP1蛋白的表达,用针对染色体9p21的FISH检测p16基因位点状态。 结果7/26间皮瘤和0/49的良性间皮细胞增生检测到BAP1缺失,14/27间皮瘤和0/40良性间皮细胞增生检测到p16基因位点缺失,二者有100%的特异性和阳性预测值。BAP1 IHC和p16 FISH检测恶性间皮增生敏感性为58%。p53、EMA、IMP3和GLUT1不同组合表现出相当高的特异性(96%〜98%),但敏感性低—极低。鉴别间皮细胞增生是良性还是恶性时,联合BAP1 IHC / p16基因FISH检测是诊断恶性间皮瘤高度特异性的方法,同时也适用于证实组织内浸润性间皮细胞。但是,联合BAP1 / P16 FISH检测并非高度敏感,其阴性结果不能除外间皮瘤。研究结果还表明,即使联合应用EMA、p53、GLUT1和IMP3,鉴别良恶性间皮细胞增生价值仍十分有限。

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