Immunohistochemical Classification of Ampullary Carcinomas: Critical Reappraisal Fails to Confirm Prognostic Relevance for Recently Proposed Panels, and Highlights MUC5AC as a Strong Prognosticator

The American Journal of Surgical Pathology
Yue XueVolkan Adsay

Abstract

Recently, immunohistochemistry-based classifications of ampullary carcinomas have been proposed (Ang and colleagues [PMID: 24832159]; Chang and colleagues [PMID: 23439753]). In this study, the prognostic value of Ang/Chang panel markers (CK20, MUC1, MUC2, CDX2) as well as other markers (CK7, MUC5AC, and MUC6) were tested on full-faced sections of 136 ampullary carcinoma resections with substantial (>5 mm) invasion. Immunohistochemistry was correlated with both histologic classification (intestinal [INT], pancreatobiliary [PB], or nontubular based on ≥3/5 observer agreement) and clinical outcome. No prognostic correlation was found with MUC1, CDX2, MUC2 or CK20 despite testing with different quantitative cutoffs. CK7 and CK20 were nonspecific. Ang classification had reasonable correlation with histologic subclassification of tubular cases as INT versus PB with high specificity but low sensitivity and ambiguous category was large (29%) and included also some classical cases. Prognostically, Ang classification approached but did not reach statistical significance, even when their large "ambiguous" group was eliminated and only tubular cases were analyzed (Ang-INT vs. Ang-PB; P=0.08). The Chang panel, in which the definition of the...Continue Reading

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Citations

Oct 16, 2019·International Journal of Surgical Pathology·Deniz TuncelVolkan Adsay
Jul 1, 2019·Journal of Clinical Pathology·Mads Rohde HarthimmerSönke Detlefsen
Nov 30, 2018·World Journal of Gastrointestinal Oncology·Antonio PeaClaudio Luchini
Jul 13, 2018·Virchows Archiv : an International Journal of Pathology·Aoife Maguire, Kieran Sheahan
Aug 11, 2020·Surgical Pathology Clinics·Yue Xue, Michelle D Reid
Apr 3, 2021·Surgery Today·Keiichi OkanoYasuyuki Suzuki
May 9, 2021·Virchows Archiv : an International Journal of Pathology·Giovanni ArpaEnrico Solcia

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