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Application of Immunohistochemistry in Cytology. 免疫组织化学在细胞学中的应用。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001086
Yan Shi, Melissa Yee-Chang, Shan-Rong Shi

Immunohistochemistry (IHC), also referred to as immunocytochemistry in cytology literature, has revolutionized the practice of cytopathology. Because of the complexity of cytology preparation and limited diagnostic material, performing IHC remains a challenge. Formalin-fixed paraffin-embedded (FFPE) cell block (CB) is the optimal choice for IHC. In this review, the approaches for improving CB preparation will be discussed. When CB material is not available, various cytology specimens can also be used for IHC. With the utilization of Antigen Retrieval (AR) technique, these nonformalin-fixed cytology specimens can achieve successful IHC staining, comparable with the results from FFPE tissue sections. In the last part of this review, we will discuss the use of positive controls and the important role of AR in standardization of IHC in cytology.

免疫组织化学(IHC),在细胞学文献中也被称为免疫细胞化学,已经彻底改变了细胞病理学的实践。由于细胞学准备的复杂性和有限的诊断材料,进行免疫组化仍然是一个挑战。甲醛固定石蜡包埋(FFPE)细胞块(CB)是免疫组化的最佳选择。本文将讨论改进炭黑制备的途径。当没有CB材料时,各种细胞学标本也可用于免疫组化。利用抗原检索(AR)技术,这些非福尔马林固定细胞学标本可以成功地进行免疫组化染色,与FFPE组织切片的结果相当。在这篇综述的最后一部分,我们将讨论阳性对照的使用和AR在细胞学IHC标准化中的重要作用。
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引用次数: 0
Histopathology of Prostate Cancer and its Precursors. 前列腺癌及其前体的组织病理学。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001067
Rodolfo Montironi, Alessia Cimadamore, Roberta Mazzucchelli, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng

Starting in the mid-1970s, we formed a group of pathologists with a major interest in uropathology. Originally, it included 2 (R.M. and M.S.). In the years the followed, the group was enlarged to include 4 more people, 2 in the mid- and late-1980s (A.L.B. and L.C.) and another in the mid-1990s (R.Ma.); a sixth (A.C.) joined the group ∼5 years ago. Two have reached the retirement age (R.M. and M.S.), while others are in the process of joining the group to replace them. A fruitful collaboration spanned for ∼45 years. This contribution is based on a series of personal recollections of the successive changes in the interpretation of prostate cancer and its precursors, starting in the mid-1970s. Here we have retraced our involvement steps, sharing issues related to them with a junior uropathologist (A.C.).

从20世纪70年代中期开始,我们组建了一个病理学家小组,主要研究泌尿病理学。最初,它包括两个(R.M.和M.S.)。在接下来的几年里,这个小组又扩大到4人,20世纪80年代中后期有2人(A.L.B.和L.C.), 20世纪90年代中期有1人(R.Ma。第六名(A.C.)是5年前加入的。两人已经达到了退休年龄(R.M.和M.S.),而其他人正在加入接替他们的行列。这一富有成果的合作持续了45年。这一贡献是基于一系列个人对前列腺癌及其前体解释的连续变化的回忆,从20世纪70年代中期开始。在这里,我们回顾了我们的参与步骤,与一位初级泌尿病理学家(A.C.)分享了与他们相关的问题。
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引用次数: 1
p53 as Exemplar Next-Generation Immunohistochemical Marker: A Molecularly Informed, Pattern-Based Approach, Methodological Considerations, and Pan-Cancer Diagnostic Applications. p53作为示例性下一代免疫组织化学标记物:一种分子知情、基于模式的方法、方法学考虑因素和泛癌诊断应用。
IF 1.3 4区 医学 Q3 ANATOMY & MORPHOLOGY Pub Date : 2023-08-01 Epub Date: 2023-07-21 DOI: 10.1097/PAI.0000000000001144
Andrew M Bellizzi

This review is based on a webinar I presented for the International Society for Immunohistochemistry and Molecular Morphology (ISIMM) in February 2022. It is intended that all ISIMM webinars will ultimately be published in AIMM as review articles. This work is also dedicated to Clive Taylor, who has deeply impacted my career. It presents a molecularly informed, pattern-based approach to p53 immunohistochemistry interpretation, methodological considerations (ie, antibody selection, optimization, validation, controls, and external quality assessment), and pan-cancer diagnostic applications, including those drawn from gastrointestinal, genitourinary, gynecological, neuroendocrine, hematologic, and neuropathology. It intends to prove the thesis statement that p53 is an exemplar next-generation immunohistochemical marker "born" ahead of its time.

这篇综述是基于我在2022年2月为国际免疫组织化学和分子形态学学会(ISIMM)举办的网络研讨会。所有ISIMM网络研讨会最终都将作为评论文章发表在AIMM上。这部作品也是献给克莱夫·泰勒的,他深深地影响了我的职业生涯。它为p53免疫组织化学解释、方法考虑(即抗体选择、优化、验证、对照和外部质量评估)和全癌诊断应用提供了一种分子知情、基于模式的方法,包括来自胃肠道、泌尿生殖道、妇科、神经内分泌、血液学和神经病理学的应用。它旨在证明p53是一种典型的下一代免疫组织化学标记物,它早于时代“诞生”。
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引用次数: 0
Clive R. Taylor: A Tribute. 克莱夫·r·泰勒:致敬。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001130
Richard J Cote
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引用次数: 0
The Story of the Magee Equations: The Ultimate in Applied Immunohistochemistry. Magee方程式的故事:应用免疫组织化学的终极。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001065
Rohit Bhargava, David J Dabbs

Magee equations (MEs) are a set of multivariable models that were developed to estimate the actual Onco type DX (ODX) recurrence score in invasive breast cancer. The equations were derived from standard histopathologic factors and semiquantitative immunohistochemical scores of routinely used biomarkers. The 3 equations use slightly different parameters but provide similar results. ME1 uses Nottingham score, tumor size, and semiquantitative results for estrogen receptor (ER), progesterone receptor, HER2, and Ki-67. ME2 is similar to ME1 but does not require Ki-67. ME3 includes only semiquantitative immunohistochemical expression levels for ER, progesterone receptor, HER2, and Ki-67. Several studies have validated the clinical usefulness of MEs in routine clinical practice. The new cut-off for ODX recurrence score, as reported in the Trial Assigning IndividuaLized Options for Treatment trial, necessitated the development of Magee Decision Algorithm (MDA). MEs, along with mitotic activity score can now be used algorithmically to safely forgo ODX testing. MDA can be used to triage cases for molecular testing and has the potential to save an estimated $300,000 per 100 clinical requests. Another potential use of MEs is in the neoadjuvant setting to appropriately select patients for chemotherapy. Both single and multi-institutional studies have shown that the rate of pathologic complete response (pCR) to neoadjuvant chemotherapy in ER+/HER2-negative patients can be predicted by ME3 scores. The estimated pCR rates are 0%, <5%, 14%, and 35 to 40% for ME3 score <18, 18 to 25, >25 to <31, and 31 or higher, respectively. This information is similar to or better than currently available molecular tests. MEs and MDA provide valuable information in a time-efficient manner and are available free of cost for anyone to use. The latter is certainly important for institutions in resource-poor settings but is also valuable for large institutions and integrated health systems.

Magee方程(MEs)是一组多变量模型,用于估计浸润性乳腺癌中Onco型DX (ODX)的实际复发评分。公式来源于标准组织病理因子和常规使用的生物标志物的半定量免疫组织化学评分。这3个方程使用的参数略有不同,但结果相似。ME1采用诺丁汉评分、肿瘤大小以及雌激素受体(ER)、孕激素受体、HER2和Ki-67的半定量结果。ME2与ME1相似,但不需要Ki-67。ME3仅包括ER、孕酮受体、HER2和Ki-67的半定量免疫组织化学表达水平。一些研究已经证实了MEs在常规临床实践中的临床应用。新的ODX复发评分截止值,如在试验分配个体化治疗方案试验中报道的那样,需要开发Magee决策算法(MDA)。MEs和有丝分裂活性评分现在可以用算法安全地放弃ODX测试。MDA可用于对病例进行分子检测的分类,每100个临床请求有可能节省约30万美元。MEs的另一个潜在用途是在新辅助环境中适当选择化疗患者。单机构和多机构研究均表明,ER+/ her2阴性患者新辅助化疗的病理完全缓解率(pCR)可通过ME3评分预测。估计pCR率为0%,25 ~
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引用次数: 1
Reinventing Nuclear Histo-score Utilizing Inherent Morphologic Cutoffs: Blue-brown Color H-score (BBC-HS). 利用固有形态学截断重新发明核组织评分:蓝棕色h评分(BBC-HS)。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001095
Phillipe Price, Usharani Ganugapati, Zoran Gatalica, Archan Kakadekar, James Macpherson, Louise Quenneville, Henrike Rees, Elzbieta Slodkowska, Janarthanee Suresh, Darryl Yu, Hyun J Lim, Emina E Torlakovic

Immunohistochemistry (IHC) is a testing methodology that is widely used for large number of diagnostic, prognostic, and predictive biomarkers. Although IHC is a qualitative methodology, in addition to threshold-based stratification (positive vs. negative), the increasing levels of expression of some of these biomarkers often lead to more intense staining, which published evidence linked to specific diagnosis, prognosis, and responses to therapy. It is essential that the descriptive thresholds between positive and negative staining, as well as between frequently used graded categories of staining intensity (eg, 1+, 2+, 3+) are standardized and reproducible. Histo-score (H-score) is a frequently used scoring system that utilizes these categories. Our study introduces categorization of the cutoff points between positive and negative results and graded categories of staining intensity for nuclear IHC biomarker assays based on color interaction between hematoxylin and diaminobenzidine (DAB); the Blue-brown Color H-score (BBC-HS). Six cases of diffuse large B-cell lymphoma were stained for a nuclear marker MUM1. The staining was assessed by H-score by 12 readers. Short tutorial and illustrated instructions were provided to readers. The novel scoring system in this study uses the interaction between DAB (DAB, brown stain) and hematoxylin (blue counterstain) to set thresholds between "0" (negative nuclei), "1+" (weakly positive nuclei), "2+" (moderately positive nuclei), and "3+" (strongly positive nuclei). The readers recorded scores for 300 cells. Krippendorff alpha (K-alpha) and intraclass correlation coefficient (ICC) were calculated. We have also assessed if reliability improved when counting the first 100 cells, first 200 cells, and for the total 300 cells using K-alpha and ICC. To assess the performance of each individual reader, the mean H-score and percent positive score (PPS) for each case was calculated, and the bias was calculated between each reader's score and the mean. K-alpha was 0.86 for H-score and 0.76 for PPS. ICC was 0.96 for H-score and 0.92 for PPS. The biases for H-score ranged from -58 to 41, whereas for PPS it ranged from -27% to 33%. Overall, most readers showed very low bias. Two readers were consistently underscoring and 2 were consistently overscoring compared with the mean. For nuclear IHC biomarker assays, our newly proposed cutoffs provide highly reliable/reproducible results between readers for positive and negative results and graded categories of staining intensity using existing morphologic parameters. BBC-HS is easy to teach and is applicable to both human eye and image analysis. BBC-HS application should facilitate the development of new reliable/reproducible scoring schemes for IHC biomarkers.

免疫组织化学(IHC)是一种广泛用于大量诊断、预后和预测生物标志物的测试方法。虽然IHC是一种定性方法,除了基于阈值的分层(阳性与阴性)之外,其中一些生物标志物表达水平的增加通常会导致更强烈的染色,这与特定的诊断、预后和治疗反应有关。至关重要的是,阳性和阴性染色之间的描述性阈值,以及经常使用的染色强度分级类别(例如,1+,2+,3+)之间的阈值是标准化和可重复的。历史分数(H-score)是一种常用的评分系统,它利用了这些类别。我们的研究介绍了基于苏木精和二氨基联苯胺(DAB)之间的颜色相互作用的核IHC生物标志物检测的阳性和阴性结果的截止点分类和染色强度的分级分类;蓝棕色h值(BBC-HS)。对6例弥漫性大b细胞淋巴瘤进行核标记物MUM1染色。12名读卡器进行h -评分。为读者提供了简短的教程和插图说明。本研究新颖的评分系统利用DAB (DAB,棕色染色)和苏木精(蓝色反染色)之间的相互作用,在“0”(阴性细胞核)、“1+”(弱阳性细胞核)、“2+”(中度阳性细胞核)和“3+”(强阳性细胞核)之间设置阈值。阅读者记录了300个细胞的分数。计算Krippendorff alpha (K-alpha)和类内相关系数(ICC)。我们还评估了在使用K-alpha和ICC计数前100个细胞、前200个细胞和总共300个细胞时,可靠性是否得到改善。为了评估每位读者的表现,计算每种情况下的平均h分和阳性分数百分比(PPS),并计算每位读者的得分与平均值之间的偏差。H-score的K-alpha为0.86,PPS的K-alpha为0.76。H-score的ICC为0.96,PPS为0.92。H-score的偏倚范围为-58 ~ 41,而PPS的偏倚范围为-27% ~ 33%。总的来说,大多数读者的偏见都很低。与平均值相比,两名读者一直在划线,两名读者一直在划线。对于核免疫组化生物标志物检测,我们新提出的截止点提供了高度可靠/可重复的阳性和阴性结果阅读器和使用现有形态学参数的染色强度分级分类。BBC-HS易于教学,适用于人眼和图像分析。BBC-HS的应用将有助于开发新的可靠/可重复的IHC生物标志物评分方案。
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引用次数: 0
Dual Expression of Immunoglobulin Light Chains in Plasma Cell Myeloma: A Case Report and Literature Review. 免疫球蛋白轻链在浆细胞骨髓瘤中的双重表达:1例报告及文献复习。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001069
Janarthanee Suresh, Yue Wu, Rathi Sabaratnam, Shashi Brijlall, Barry Kyle, Emina E Torlakovic

Typically, myeloma cells express a monoclonal immunoglobulin (Ig), either heavy or light chain. Here, we present a case of multiple myeloma with clonal dual expression of kappa and lambda light chain in a 74-year-old woman. Awareness of rare biphenotypic myeloma is important for proper diagnostic workup. A 74-year-old woman underwent hip replacement with an incidental finding of 20% plasma cells in the femoral head. Subsequent bone marrow biopsy also showed about 30% of plasma cells negative for CD20, CD56, and CD117. Immunohistochemistry (IHC) and in situ hybridization studies showed a mixture of kappa and lambda plasma cells. Flow cytometry showed ambiguous results for cytoplasmic Ig light chains kappa and lambda. However, cyclin D1 was highly expressed by plasma cells, and increased free kappa light chains were identified in serum. Further investigation by double IHC demonstrated co-expression of kappa and lambda light chains in the same cells. Fluoresces in situ hybridization studies were positive for t(11;14)(q13;q32) and the deletion 13q. Since its first description by Taylor and Burns in 1974, the demonstration of restricted cytoplasmic Ig light chain expression by immunohistochemistry is 1 of the basic tools for corroborating clonality of the plasma cells in tissue biopsy. IHC results in myeloma with dual expression of Ig light chains may suggest polyclonal plasma cell population, especially when plasma cells do not form sheets in the bone marrow. In an appropriate clinical setting, other investigations are needed to exclude plasma cell neoplasm, even with seemingly "polytypic" results by IHC.

通常,骨髓瘤细胞表达单克隆免疫球蛋白(Ig),或重链或轻链。在这里,我们提出一例多发性骨髓瘤与克隆双表达kappa和lambda轻链在一个74岁的妇女。认识罕见的双表型骨髓瘤是重要的正确诊断工作。一名74岁女性接受髋关节置换术,意外发现股骨头内有20%浆细胞。随后的骨髓活检也显示约30%的浆细胞CD20、CD56和CD117呈阴性。免疫组织化学(IHC)和原位杂交研究显示kappa和lambda浆细胞的混合物。流式细胞术显示细胞质Ig轻链kappa和lambda的结果不明确。而cyclin D1在浆细胞中高表达,血清中游离kappa轻链增加。进一步的双IHC研究表明kappa和lambda轻链在同一细胞中共同表达。荧光原位杂交研究为t(11;14)(q13;q32)和缺失13q阳性。自1974年Taylor和Burns首次对其进行描述以来,免疫组织化学证明胞质Ig轻链表达受限是组织活检中证实浆细胞克隆性的基本工具之一。免疫组化导致的骨髓瘤Ig轻链双表达可能提示多克隆浆细胞群,特别是当浆细胞在骨髓中不形成片状时。在适当的临床环境中,需要进行其他检查以排除浆细胞肿瘤,即使免疫结构检测结果看似“多型”。
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引用次数: 0
Pathology of Crooke Cells in the Human Pituitaries: A Timely Review. 人类垂体Crooke细胞的病理学:及时回顾。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001070
Robert Y Osamura, Chie Inomoto, Shigeyuki Tahara, Ken-Ichi Oyama, Akira Matsuno, Akira Teramoto

Crooke cell change was first found in the regressed and suppressed corticotroph (adrenocorticotropic hormone-producing) cells, and now is known to occur in pituitary tumors. The tumor cells of this type can be recognized by morphology with immunohistochemistry, and are well known to predict aggressive behavior such as invasion and rare metastases. This is one of the representative neuroendocrine tumors in the pituitary which is now considered to have malignant potential as proposed in the pancreas and gastrointestinal tracts. It is important to emphasize the pituitary tumor pathology such as Crooke cell change for prognostication and appropriate therapies. This review article describes the evolution from the Crooke cells to Crooke cell tumors which is timely along with the Fifth WHO classification 2022 published online.

克鲁克细胞改变最初发现于退化和抑制的促皮质细胞(促肾上腺皮质激素的产生),现在已知发生在垂体肿瘤中。这种类型的肿瘤细胞可以通过免疫组织化学形态学识别,并且众所周知,它可以预测侵袭性行为,如侵袭和罕见的转移。这是垂体中具有代表性的神经内分泌肿瘤之一,现在认为在胰腺和胃肠道中有恶性潜能。强调垂体肿瘤病理如克鲁克细胞改变对预后和适当治疗具有重要意义。这篇综述文章描述了从克鲁克细胞到克鲁克细胞肿瘤的演变,这与世卫组织第五次分类2022在网上发布是及时的。
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引用次数: 0
The Biomarker Ki-67: Promise, Potential, and Problems in Breast Cancer. 生物标志物Ki-67:乳腺癌的前景、潜力和问题。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001087
Allen M Gown

Ki-67 is a nuclear protein serendipitously discovered by monoclonal antibody selection in the early 1980s. While it has been applied for decades in the context of breast cancer as a putative prognostic and, more recently, predictive, biomarker, even after all this time there is incomplete agreement as to the validity of the immunohistochemical assays employed for Ki-67 assessment, given possible effects of the disparate methodologies employed and possible confounding preanalytical, analytical, and interpretive variables. In this brief review, the history of Ki-67 and the problems, particularly with the analytical and interpretive variables, are highlighted through a selective review of the published literature. The contributions of the International Ki-67 Breast Cancer Working Group are highlighted, and in particular, the recommendations made by this group are reviewed. The potential of Ki-67 as a biomarker for breast cancer has not yet been fully realized, but an understanding of the power as well as the limitations of the methods of Ki-67 assessment are important if this biomarker can realize its potential.

Ki-67是20世纪80年代初在单克隆抗体选择中偶然发现的一种核蛋白。虽然它作为一种假定的预后和最近的预测性生物标志物在乳腺癌的背景下已经应用了几十年,但考虑到所采用的不同方法可能产生的影响以及可能混淆的分析前、分析和解释变量,即使经过了这么长时间,对于用于Ki-67评估的免疫组织化学分析的有效性仍存在不完全一致的意见。在这篇简短的综述中,Ki-67的历史和问题,特别是分析和解释变量,通过对已发表文献的选择性回顾来强调。强调了国际Ki-67乳腺癌工作组的贡献,并特别审查了该工作组提出的建议。Ki-67作为乳腺癌生物标志物的潜力尚未被充分认识到,但如果这种生物标志物能够发挥其潜力,了解Ki-67评估方法的能力和局限性是很重要的。
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引用次数: 2
Gorgeous 50 Years in Immuno-Molecular Morphology (IMM) With Dr Clive Taylor: A Tribute to My Friend and Mentor. 与克莱夫·泰勒博士在免疫分子形态学(IMM)上的辉煌50年:向我的朋友和导师致敬。
IF 1.6 4区 医学 Q2 Health Professions Pub Date : 2023-08-01 DOI: 10.1097/PAI.0000000000001064
Robert Y Osamura
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引用次数: 0
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Applied Immunohistochemistry & Molecular Morphology
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