CK20 versus AMACR and p53 immunostains in evaluation of Urothelial Carcinoma in Situ and Reactive Atypia

Ancillary testing with immunohistochemistry has shown recent promise in the workup of equivocal bladder lesions. We read with interest the recent findings of Alston et al., who assessed the diagnostic utility of alpha-methylacyl-CoA racemase (AMACR) in comparison to cytokeratin 20 (CK20) in evaluation of atypia in challenging flat urothelial lesions in the differential between carcinoma in situ (CIS) and reactive atypia. AMACR was reported to be a somewhat more specific but less sensitive marker for CIS than CK20, though showing weaker intensity. Spurred by their report, with the knowledge that we had consistently and consecutively performed AMACR, CK20, and p53 on flat urothelial lesions challenging enough to reach intradepartmental consensus, we performed a retrospective review. Similarly, we found that AMACR was less sensitive (80%) and more specific (100%) than CK20, with the same caveat of less staining intensity. Additionally, our p53 review identified a significant rate (~ 27%) of equivocal/non-informative findings. Taken together, our experience in this consecutive cohort confirms the impression of Alston et al. regarding the utility and challenges of AMACR use, while highlighting challenges with p53, which we plan to use more sparingly prospectively.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:15

Enthalten in:

Diagnostic pathology - 15(2020), 1 vom: 26. Mai, Seite 61

Sprache:

Englisch

Beteiligte Personen:

Neal, Daniel J [VerfasserIn]
Amin, Mahul B [VerfasserIn]
Smith, Steven C [VerfasserIn]

Links:

Volltext

Themen:

Alpha-methylacyl-CoA racemase
Biomarkers, Tumor
Cytokeratin 20
EC 5.1.-
EC 5.1.99.4
KRT20 protein, human
Keratin-20
Letter
Racemases and Epimerases
TP53 protein, human
Tumor Suppressor Protein p53
Urothelial carcinoma in situ

Anmerkungen:

Date Completed 31.03.2021

Date Revised 31.03.2021

published: Electronic

Citation Status MEDLINE

doi:

10.1186/s13000-020-00984-2

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM310387302