Value of direct immunohistochemical staining in assisting intraoperative frozen diagnosis of bronchiolar adenoma.
10.3760/cma/j.cn112151-20220829-00739
- Author:
Bo ZHENG
1
;
Shuan Mei ZOU
1
;
Lin YANG
1
;
Xue Min XUE
1
;
Chang Yuan GUO
1
;
Long WANG
1
;
Wen Chao LIU
1
;
Zhao Zhao ZHOU
1
;
Xin LIU
1
;
Li Yan XUE
1
Author Information
1. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Paraffin;
Sensitivity and Specificity;
Adenocarcinoma in Situ;
Adenoma/diagnosis*;
Adenocarcinoma, Mucinous/surgery*;
Frozen Sections/methods*
- From:
Chinese Journal of Pathology
2023;52(2):142-146
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the feasibility and application value of intraoperative direct immunohistochemical (IHC) staining in improving the diagnosis accuracy in difficult cases of bronchiolar adenoma (BA). Methods: Nineteen cases with single or multiple pulmonary ground-glass nodules or solid nodules indicated by imaging in Cancer Hospital of Chinese Academy of Medical Sciences from January to July 2021 and with difficulty in differential diagnosis at frozen HE sections were selected. In the experimental group, direct IHC staining of cytokeratin 5/6 (CK5/6) and p63 was performed on frozen sections to assist the differentiation of BA from in situ/micro-invasive adenocarcinoma/adenocarcinoma/invasive mucinous adenocarcinoma. In the control group, two pathologists performed routine frozen HE section diagnosis on these 19 cases. The diagnostic results of paraffin sections were used as the gold standard. The sensitivity and specificity of BA diagnosis, consistency with paraffin diagnosis and time used for frozen diagnosis were compared between the experimental group and the control group. Results: The basal cells of BA were highlighted by CK5/6 and p63 staining. There were no basal cells in the in situ/microinvasive adenocarcinoma/adenocarcinoma/invasive mucinous adenocarcinoma. In the experimental group, the sensitivity and specificity with aid of direct IHC staining for BA were 100% and 86.7%, respectively, and the Kappa value of frozen and paraffin diagnosis was 0.732, and these were significantly higher than those in the control group (P<0.05). The average time consumption in the experimental group (32.4 min) was only 7 min longer than that in the control group (25.4 min). Conclusions: Direct IHC staining can improve the accuracy of BA diagnosis intraoperatively and reduce the risk of misdiagnosis, but require significantly longer time. Thus frozen direct IHC staining should be restricted to cases with difficulty in differentiating benign from malignant diseases, especially when the surgical modalities differ based on the frozen diagnosis.
