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Transcription Factor Immunohistochemistry Improves Diagnostic Accuracy and Reduces Immunonegative Misclassification
Thomas Hanks1, Zachary A Abecassis1, Jessica Eaton1
1University of Washington School of Medicine, Department of Neurological Surgery, 1959 NE Pacific St, Box 356470, Seattle WA, USA, 98195.
Objective:
Anterior pituitary hormone immunohistochemistry (IHC) for surgically resected nonfunctional pituitary neuroendocrine tumors (NF PitNET) underreports true rates of tumor lineage and biases toward immunonegative tumors. Here we compare our use of traditional IHC methods for identification of anterior pituitary hormones versus identification of lineage specific transcription factors (TF) to correctly identify NF PitNET lineage and review the literature for studies evaluating its efficacy.
Methods:
A single institution, retrospective study of NF PitNETs undergoing surgical resection between 2021 and 2024 at the University of [blinded for review] was performed. Patients were included for study if pathology specimens had IHC performed for anterior pituitary hormones and lineage specific TF.
Results:
A total of 173 patients with NF PitNETs were included. When stained for the lineage specific TFs: SF-1, PIT-1, and T-PIT, immunoreactivity was observed in 117 (66%), 18 (10%), and 35 (20%) tumors, respectively. Three (2%) patients demonstrated no positive staining for any TF and were classified as immunonegative. Of the 117 SF-1 tumors, 32 (27%) showed no positive staining for LH/FSH. For the 18 PIT-1 tumors, two (11%) showed no positive staining for PRL/GH/TSH. For the 35 TPIT tumors, 7 (20%) showed no staining for ACTH. Overall, of the 170 patients who had positive staining for a single TF, 41 (24%) did not show IHC staining for their corresponding anterior pituitary hormones and thus would have been classified as immunonegative PitNETs.
Conclusion:
Use of IHC for identification of lineage specific TF markedly improves the accuracy of correct pathological diagnosis of NF PitNETs.
