TY - JOUR
T1 - Proliferation indices correlate with diagnosis and metastasis in diagnostically challenging melanocytic tumors
AU - Al-Rohil, Rami N.
AU - Curry, Jonathan L.
AU - Torres-Cabala, Carlos A.
AU - Nagarajan, Priyadharsini
AU - Ivan, Doina
AU - Aung, Phyu P.
AU - Lyons, Genevieve F.
AU - Bassett, Roland L.
AU - Prieto, Victor G.
AU - Tetzlaff, Michael T.
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Summary The diagnosis of melanocytic lesions remains a formidable challenge in dermatopathology. For diagnostically challenging lesions, ancillary tests are available to inform the diagnosis, including immunohistochemistry and molecular testing (particularly fluorescence in situ hybridization [FISH]). However, the test result that most robustly informs the diagnosis remains controversial. Thirty-seven diagnostically challenging melanocytic lesions from our consultation service were reviewed. Histopathologic, immunohistochemical, and second-generation FISH results (NeoGenomics; probes 6p25, 8q24, 11q13, 9p21, and centromere 9) were correlated with the final consensus diagnosis and clinical follow-up using logistic regression and Fisher exact test. Based on histopathologic and immunohistochemical features, cases were designated as "favor benign" (n = 19) or "favor malignant" (n = 18) by a consensus group of up to 7 dermatopathologists. The sensitivity of FISH for the diagnosis of melanoma was 39%, and the specificity was 84%. Univariate logistic regression models for a final diagnosis of melanoma showed that only increased Ki-67-positive dermal tumor cells (≥ 5%; P =.01) significantly correlated with the diagnosis of melanoma. FISH result did not correlate with the final diagnosis (melanoma or nevus; P =.26). Follow-up (range, 8-29 months) was available for 35 cases (19 diagnosed as nevus and 16 as melanoma), and metastases (restricted to sentinel lymph nodes) were detected from 5 melanomas (3 FISH negative and 2 FISH positive). Only increased dermal mitotic figures (> 1/mm2) correlated with metastases to sentinel lymph nodes (P =.04). Thus, in the classification of diagnostically challenging melanocytic lesions, indices of proliferation emerge as the most informative diagnostic adjuncts - correlating with diagnosis and clinical behavior, respectively.
AB - Summary The diagnosis of melanocytic lesions remains a formidable challenge in dermatopathology. For diagnostically challenging lesions, ancillary tests are available to inform the diagnosis, including immunohistochemistry and molecular testing (particularly fluorescence in situ hybridization [FISH]). However, the test result that most robustly informs the diagnosis remains controversial. Thirty-seven diagnostically challenging melanocytic lesions from our consultation service were reviewed. Histopathologic, immunohistochemical, and second-generation FISH results (NeoGenomics; probes 6p25, 8q24, 11q13, 9p21, and centromere 9) were correlated with the final consensus diagnosis and clinical follow-up using logistic regression and Fisher exact test. Based on histopathologic and immunohistochemical features, cases were designated as "favor benign" (n = 19) or "favor malignant" (n = 18) by a consensus group of up to 7 dermatopathologists. The sensitivity of FISH for the diagnosis of melanoma was 39%, and the specificity was 84%. Univariate logistic regression models for a final diagnosis of melanoma showed that only increased Ki-67-positive dermal tumor cells (≥ 5%; P =.01) significantly correlated with the diagnosis of melanoma. FISH result did not correlate with the final diagnosis (melanoma or nevus; P =.26). Follow-up (range, 8-29 months) was available for 35 cases (19 diagnosed as nevus and 16 as melanoma), and metastases (restricted to sentinel lymph nodes) were detected from 5 melanomas (3 FISH negative and 2 FISH positive). Only increased dermal mitotic figures (> 1/mm2) correlated with metastases to sentinel lymph nodes (P =.04). Thus, in the classification of diagnostically challenging melanocytic lesions, indices of proliferation emerge as the most informative diagnostic adjuncts - correlating with diagnosis and clinical behavior, respectively.
KW - Diagnostically challenging melanocytic lesions
KW - Fluorescence in situ hybridization
KW - Immunohistochemistry
KW - Melanoma
KW - Nevus
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U2 - 10.1016/j.humpath.2016.02.019
DO - 10.1016/j.humpath.2016.02.019
M3 - Article
C2 - 27004944
AN - SCOPUS:84964561950
SN - 0046-8177
VL - 53
SP - 73
EP - 81
JO - Human Pathology
JF - Human Pathology
ER -