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Immunohistochemistry usage profile in a Malaysian tertiary hospital's histopathology laboratory
P L Cheah1, Y T Chau2, L M Looi2
1University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia. cheahpl@ummc.edu.my.
Insights
Histopathology departments utilize immunohistochemistry (IHC) stains in 21.1% of cases. Individual pathologist preferences, not experience, drive antibody selection and usage patterns for IHC testing.
Area of Science:
- Pathology
- Histopathology
- Laboratory Medicine
Background:
- Immunohistochemistry (IHC) usage has significantly increased over 30 years.
- A review of IHC utilization was timely due to limited literature.
- The study focuses on IHC practices at the University of Malaya Medical Centre.
Purpose of the Study:
- To analyze the utilization patterns of immunohistochemistry (IHC) stains.
- To investigate factors influencing the choice and frequency of IHC antibody usage.
- To assess IHC usage in an academic pathology department.
Main Methods:
- Retrieved all histopathological examination cases from July 2018 to June 2019.
- Tabulated all IHC requests, excluding specific biopsy types and targeted treatment stains.
- Analyzed IHC stain usage across 14 histopathologists.
Main Results:
- IHC was performed in 2044 (21.1%) of 9686 total cases.
- A total of 5969 IHC stains were performed, averaging 2.9 stains per case.
- Ki67 and MNF116 showed higher variability in usage, suggesting differing pathologist preferences.
Conclusions:
- IHC utilization at the center aligns with academic standards.
- Histopathologists' personal preferences significantly influence IHC antibody selection.
- Years of experience did not correlate with differences in IHC stain usage patterns.
Introduction:
Immunohistochemistry (IHC) was commenced in 1986 at the Department of Pathology, University of Malaya Medical Centre, Kuala Lumpur and its usage has grown for the past 30 over years, hence it was felt that a review was timely in view of the scarcity of literature on IHC usage.
Materials And Methods:
All cases received by the Department of Pathology for histopathological examination between 1 July 2018 and 30 June 2019 were retrieved from the Laboratory Information System (LIS). All the IHC requests over this period were tabulated, with the exception of renal, muscle, rectal and nerve biopsies with their pre-defined algorithms for stains and cytological specimens. IHC stains performed solely for purpose of directing targeted treatment were also not included.
Results:
Immunohistochemistry was performed in 2044 (21.1%) of the total of 9686 cases, with a total of 5969 IHC stains performed i.e. 2.9 (5969/2044) IHC stains per case. All 91 antibodies available were used at least once during the study. 14 histopathologists (5 with < 10-years and 9 with ≥ 10-years postgraduate specialist experience) reported on the cases with no significant difference (p=0.90) in their usage of IHC stains. Among the most common IHC stains used, requests for Ki67 and MNF116 showed higher standard deviations compared with p63, CK7 and S100 among the histopathologists. From the relatively higher standard deviation for Ki67 and MNF116 it appeared that there was a greater difference in the requesting pattern between histopathologists for these two antibodies.
Conclusion:
The rate of use of IHC in our centre seems compatible with that of an academic centre. Personal preferences of the histopathologists, rather than years of postgraduate specialist experience appeared to influence the rate of usage and choice of antibodies.