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Published on: January 21, 2019
Increased utilization, verification, and clinical implications of immunocytochemistry: Experience in a northern New
Jennifer L Sauter1,2, Abiy B Ambaye1,2, Sharon L Mount1,2
1Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont.
Insights
Diagnostic immunocytochemistry (ICC) use increased, but verification revealed some unreliable antibodies in liquid-based cytology (LBC). No adverse outcomes occurred, but antibody reliability should be confirmed before diagnostic use.
Area of Science:
- Pathology
- Cytopathology
- Immunohistochemistry
Background:
- Diagnostic immunocytochemistry (ICC) utilization has significantly increased.
- Antibody reliability is crucial for accurate ICC results.
Purpose of the Study:
- To report institutional experience with antibody utilization, verification, and clinical implications in diagnostic ICC.
- To assess the reliability of antibodies in liquid-based cytology (LBC) compared to surgical pathology specimens.
Main Methods:
- Performed parallel ICC on LBC and immunohistochemistry (IHC) on formalin-fixed paraffin-embedded (FFPE) tissues for 71 antibodies.
- Reviewed cytology and surgical pathology reports for cases using antibodies that failed verification.
Main Results:
- ICC utilization increased from 5% to 15% of non-Pap/non-urine cytology cases between 2007 and 2011.
- Seven antibodies (calretinin, CD5, c-kit/CD117, inhibin, napsin A, OCT 3/4, PAX-5) were found unreliable in LBC despite consistent IHC reactivity in FFPE.
- No adverse clinical outcomes were associated with the use of non-verified antibodies.
Conclusions:
- While most antibodies were reliable, verification identified several inconsistent ones for LBC.
- Preverification use of inconsistent antibodies did not lead to adverse clinical outcomes in this series.
- Institutions are encouraged to confirm antibody reliability before diagnostic ICC use.
Background:
We report our experience in utilization, verification, and clinical implications of antibodies for use in diagnostic immunocytochemistry (ICC).
Methods:
A computer search identified cytology cases utilizing ICC and corresponding surgical pathology material. Alcohol-fixed liquid based cytology (LBC) specimens were generated from surgical pathology bench specimens. ICC on LBC and immunohistochemistry on formalin fixed paraffin embedded tissue (FFPE) were performed in parallel for 71 commonly used antibodies. Cytology and corresponding surgical pathology reports were reviewed for all cases in which antibodies failed verification studies but had been used in the four years prior to implementation of our verification process.
Results:
From 2007 to 2011, the number of cytology cases in which ICC was performed increased from 98 (or 5% of all non-Pap test/nonurine cytology cases in our laboratory) to 306 (or 15%). Verification studies revealed calretinin, CD5, c-kit/CD117, inhibin, napsin A, OCT 3/4, and PAX-5 to be nonreliable in LBC despite consistent immunoreactivity in concurrent IHC on surgical specimens. No antibodies were found to be immunoreactive on LBC but nonreactive on FFPE. No adverse clinical outcomes resulted from the use of nonverified antibodies.
Conclusions:
Utilization of ICC at our institution has increased dramatically in recent years. Our verification process confirmed reliability in the majority of antibodies, but did identify several inconsistent antibodies. Although, in our series, no adverse clinical outcomes resulted from preverification use of these inconsistent antibodies, we encourage other institutions to confirm reliability of antibodies prior to use for diagnostic ICC.
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