The Predictive Ability of a CK5/p63/CK8/18 Antibody Cocktail in Stratifying Breast Papillary Lesions on Needle Biopsy

Reisenbichler, Emily S.; Adams, Amy L.; Hameed, Omar
December 2013
American Journal of Clinical Pathology;Dec2013, Vol. 140 Issue 6, p767
Academic Journal
Objectives Objectives Immunohistochemical markers have been sh Objectives Objectives own to assist in the stratification of breast papillary lesions. We evaluated the ability of different cytokeratin (CK) and p63 expression profiles on needle biopsy specimens to predict excision diagnoses. Methods Methods A CK5/p63/CK8/18 antibody cocktail was appl Methods Methods ied to 58 needle biopsy specimens (32 papillomas, 7 atypical papillomas, 19 papillary carcinomas on excision). Results Results p63 expression was greater in papillomas th Results Results an in atypical papillomas (P = .044) and papillary carcinomas (P< .0001). Papillary carcinomas and atypical papillomas showed greater CK8/18 expression (and conversely less CK5 expression) than did papillomas (P < .0001). Negative or focal p63 expression was 96% sensitive for diagnosing any atypical lesion (atypical papilloma or papillary carcinoma) on excision, whereas CK8/18 predominant expression (=80% cells) was 100% sensitive. In contrast, the sensitivity of the original diagnosis was only 81%. The greatest accuracy for the diagnosis of atypical papillary lesions (95%) was achieved when both p63 and cytokeratins were used in combination in an algorithmic fashion. This method also correctly identified all cases that had papillary carcinoma (100% sensitivity) on excision. Conclusions Conclusions Although a single stain or combination Conclusions Conclusions cannot independently stratify papillary lesions, a CK5/p63/CK8/18 antibody cocktail is a useful adjunct to morphology for evaluating breast papillary lesions in needle biopsy specimens.


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