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    Patterns in immunohistochemical usage in extended core prostate biopsies: comparisons among genitourinary pathologists and nongenitourinary pathologists

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    Authors
    Plourde, Anna
    Gross, Alden
    Jiang, Zhong
    Owens, Christopher L.
    Faculty Advisor
    Christopher Owens
    UMass Chan Affiliations
    Department of Pathology
    Document Type
    Journal Article
    Publication Date
    2013-11-01
    Keywords
    Biopsy, Large-Core Needle
    Humans
    Immunohistochemistry
    Male
    Pathology, Clinical
    Prostate
    Prostatic Neoplasms
    Staining and Labeling
    Diagnosis
    Health Services Administration
    Investigative Techniques
    Male Urogenital Diseases
    Neoplasms
    Other Analytical, Diagnostic and Therapeutic Techniques and Equipment
    Pathology
    Surgical Procedures, Operative
    Urogenital System
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    Link to Full Text
    https://doi.org/10.5858/arpa.2012-0517-OA
    Abstract
    CONTEXT: Immunohistochemical (IHC) stains have known utility in prostate biopsies and are widely used to augment routine staining in difficult cases. Patterns in IHC utilization and differences based on pathologist training and experience is understudied in the peer-reviewed literature. OBJECTIVES: To compare the rates of IHC usage between specialized (genitourinary; [GU]) and nonspecialized (non-GU) pathologists in extended core prostate biopsies (ECPBs) and the effects of diagnosis; and in cancer cases Gleason grade, disease extent, and perineural invasion on the rate. DESIGN: Consecutive ECPBs from 2009-2011 were identified and billing data were used to determine the number of biopsies and IHC stains per case. Diagnoses were mapped and in cancer cases, Gleason grade, extent of disease, and perineural invasion were recorded. Pathologists were classified as GU or non-GU on the basis of training and experience. RESULTS: A total of 618 ECPBs were included in the study. Genitourinary pathologists ordered significantly fewer IHC tests per case and per biopsy than non-GU pathologists. The rate of ordering was most disparate for biopsies of cancerous and benign lesions. For biopsies of cancerous lesions, high-grade cancer, bilateral disease, and perineural invasion decreased the rate of ordering in both groups. In cancer cases, GU pathologists ordered significantly fewer stain tests for highest Gleason grade of 3 + 3 = 6, for patients with focal disease and for patients with multiple positive bilateral cores. The effect of the various predictors on IHC ordering rates was similar in both groups. CONCLUSIONS: Genitourinary pathologists ordered significantly fewer IHC stain tests than non-GU pathologists in ECPBs. Guidelines to define when IHC workup is necessary and not necessary may be helpful to guide workups.
    Source

    Arch Pathol Lab Med. 2013 Nov;137(11):1630-4. doi: 10.5858/arpa.2012-0517-OA. Link to article on publisher's site

    DOI
    10.5858/arpa.2012-0517-OA
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49256
    PubMed ID
    24168501
    Notes

    Medical student Anna Plourde participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.5858/arpa.2012-0517-OA
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    T.H. Chan School of Medicine Student Publications
    Senior Scholars Program

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