Premium
Detecting metastatic prostate carcinoma in pelvic lymph nodes following neoadjuvant hormone therapy: the eyes have it!
Author(s) -
Kehr Elizabeth,
Masry Paul,
Lis Rosina,
Loda Massimo,
Taplin MaryEllen,
Hirsch Michelle S
Publication year - 2016
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12739
Subject(s) - medicine , prostate , prostate carcinoma , lymph , hormone therapy , carcinoma , neoadjuvant therapy , oncology , hormonal therapy , radiology , urology , prostate cancer , pathology , cancer , breast cancer
Aims Residual cancer morphology in radical prostatectomies ( RP s) after neoadjuvant hormone therapy includes inconspicuous cytology, and treated tumour cells can be difficult to identify in lymph nodes. The aim of this study was to evaluate the role of immunohistochemistry ( IHC ) in identifying occult lymph node metastases following neoadjuvant hormone treatment of prostate cancer. Methods and results One hundred and twenty‐eight lymph nodes from 24 patients treated with neoadjuvant hormone therapy, including abiraterone acetate alone or combined with leuprolide, were stained with antibodies against keratin AE 1/ AE 3, prostate‐specific antigen ( PSA ), prostate‐specific acid phosphatase (Pr AP ), androgen receptor ( AR ), and NKX 3.1. IHC slides were scored ‘blind’, and then retrospectively compared with haematoxylin and eosin (H&E)‐stained slides and pathology reports. IHC identified carcinoma in six lymph nodes from three patients. All metastases were positive for NKX 3.1 and AR , five of six were positive for AE 1/ AE 3, and three of six were positive for PSA ; Pr AP was negative in all metastatic foci. All six lymph node metastases had been identified by H&E staining at the time of RP . Conclusions These findings suggest that routine use of IHC on lymph nodes from neoadjuvant‐treated prostate carcinomas is not necessary. Nevertheless, for suspicious small foci of atypical cells in neoadjuvant‐treated lymph nodes, NKX 3.1 and AR appear to have the greatest sensitivity.