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Utilization and Utility of Immunohistochemistry in Dermatopathology

Naert, Karen A., MD; Trotter, Martin J., MD, PhD

The American Journal of Dermatopathology: February 2013 - Volume 35 - Issue 1 - p 74–77
doi: 10.1097/DAD.0b013e31825d4f73
Original Study
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Abstract: Immunohistochemistry (IHC) is considered a valuable ancillary tool for dermatopathology diagnosis, but few studies have measured IHC utilization by dermatopathologists or assessed its diagnostic utility. In a regionalized, community-based dermatopathology practice, we measured IHC utilization (total requests, specific antibodies requested, and final diagnosis) over a 12-month period. Next, we assessed diagnostic utility by comparing a preliminary “pre-IHC” diagnosis based on routine histochemical staining with the final diagnosis rendered after consideration of IHC results. The dermatopathology IHC utilization rate was 1.2%, averaging 3.6 stains requested per case. Melanocytic, hematolymphoid, and fibrohistiocytic lesions made up 23%, 18%, and 16%, respectively, of the total cases requiring IHC. S100 and Melan A were the most frequently requested stains, ordered on 50% and 34% of IHC cases, respectively. The utility study revealed that IHC changed the diagnosis in 11%, confirmed a diagnosis, or excluded a differential diagnosis in 77%, and was noncontributory in 4% of cases. Where IHC results prompted a change in diagnosis, 14% were a change from a benign to malignant lesion, whereas 32% changed from one malignant entity to another. IHC is most commonly used in cutaneous melanocytic and hematolymphoid lesions. In 11% of dermatopathology cases in which IHC is used, information is provided that changes the H&E diagnosis. Such changes may have significant treatment implications. IHC is noncontributory in only a small percentage of cases.

Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada.

Reprints: Martin J. Trotter, MD, PhD, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary Laboratory Services, 9-3535 Research Road NW, Calgary, Alberta T2L 2K8, Canada (e-mail: martin.trotter@cls.ab.ca).

Conflicts of interest and sources of funding: None declared.

© 2013 by Lippincott Williams & Wilkins.