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Use of immunohistochemistry in routine workup of prostate needle biopsies: a tertiary academic institution experience
Kristalee Watson1, Cheng Wang, Asli Yilmaz
1Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services and Rockyview General Hospital, Calgary, Alberta, Canada T2V 1P9.
Insights
Immunohistochemistry is frequently used in prostate biopsies to diagnose cancer and resolve ambiguity. This study details its routine use, costs, and impact on diagnostic turnaround times.
Area of Science:
- Pathology
- Oncology
- Medical Diagnostics
Background:
- Diagnostic immunohistochemistry (IHC) in prostate needle biopsies is well-studied.
- Routine IHC use, quality assurance, and costs in prostate biopsies remain underexplored.
Purpose of the Study:
- To investigate the routine application of immunohistochemistry in prostate biopsies.
- To evaluate turnaround times, diagnostic outcomes, consultation rates, and associated costs.
Main Methods:
- Retrospective review of 748 consecutive prostate biopsy reports.
- Analysis of immunohistochemistry utilization, diagnostic breakdown, consultation rates, and cost data.
Main Results:
- Immunohistochemistry was used in 39.4% of biopsies, increasing turnaround time by 1.7 days.
- It aided in diagnosing cancer (47.7%) and resolving ambiguity in 65.4% of assessed blocks.
- Average cost per biopsy was $22.34, with an estimated annual cost of $33,420.64.
Conclusions:
- Immunohistochemistry is integral to routine prostate biopsy practice for cancer diagnosis and quality assurance.
- Findings provide a benchmark for comparing IHC utilization and costs across different institutions.
Context:
Diagnostic use of immunohistochemistry has been extensively studied in prostate needle biopsy, but its use in routine practice and the quality assurance and associated cost have not been previously addressed.
Objective:
To examine the routine use of immunohistochemistry in prostate biopsies in a tertiary academic institution.
Design:
We reviewed reports of 748 consecutive prostate biopsies and we evaluated the turnaround times, the final diagnosis on individual specimens, the intradepartmental consultation rates, and the associated costs.
Results:
Immunohistochemistry evaluation was required for 39.4% of biopsies and 12% of blocks (average 1.8 blocks/case). The biopsies with immunohistochemistry were signed out 1.7 workdays later (8.6 versus 6.9 days). The diagnostic breakdown for individual blocks evaluated by immunohistochemistry was Cancer 47.7%; Atypical, Suspicious 10.8%; Small Atypical Glands Adjacent to High-Grade Prostatic Intraepithelial Neoplasia 6.9%; High-Grade Prostatic Intraepithelial Neoplasia 12.4%; and Benign 22.2%. Diagnoses of Cancer or Atypical, Suspicious (Atypical, Suspicious + Small Atypical Glands Adjacent to High-Grade Prostatic Intraepithelial Neoplasia) were rendered in 65.4% of individual blocks assessed by immunohistochemistry. Immunohistochemistry aided in establishing limited cancer (≤10% of core) in 69.3% of cases and in 74% of single-core-positive biopsies. Departmental consultation was performed in 18.3% of biopsies and immunohistochemistry was used in 68% of these cases. Both immunohistochemistry and consultation were performed in 55.8% of Atypical, Suspicious cases. The average immunohistochemistry cost per biopsy was $22.34 and the estimated annual cost for prostate biopsy immunohistochemistry in our laboratory was $33 420.64.
Conclusions:
Immunohistochemistry is frequently used in our prostate biopsy practice to establish or confirm a limited Cancer diagnosis, to better resolve diagnostic ambiguity, or for quality assurance. The data provided herein can be used for comparisons with other prostate biopsy practices.
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