Detection of prostate cancer by α-methylacyl CoA racemase (P504S) in needle biopsy specimens previously reported as negative for malignancy
Article first published online: 20 APR 2006
Volume 48, Issue 6, pages 668–673, May 2006
How to Cite
Carswell, B. M., Woda, B. A., Wang, X., Li, C., Dresser, K. and Jiang, Z. (2006), Detection of prostate cancer by α-methylacyl CoA racemase (P504S) in needle biopsy specimens previously reported as negative for malignancy. Histopathology, 48: 668–673. doi: 10.1111/j.1365-2559.2006.02409.x
- Issue published online: 20 APR 2006
- Article first published online: 20 APR 2006
- Date of submission 6 September 2005 Accepted for publication 19 September 2005
- α-methylacyl CoA racemase;
- false-negative prostatic needle biopsy;
- prostatic cancer
Aims : To investigate the possibility of detecting small focal prostatic cancer by α-methylacyl CoA racemase (AMACR)/P504S immunohistochemistry on needle biopsy specimens that were previously interpreted as negative for carcinoma on routine haematoxylin and eosin (H&E)-stained sections.
Methods : Prostate needle biopsy specimens (n = 793) previously interpreted as benign prostatic tissue by conventional morphology from 239 patients with prostatic cancer diagnosed in other biopsy cores taken at the same biopsy session were stained with the P504S monoclonal antibody. If a biopsy specimen stained positively, two pathologists independently reviewed the original corresponding H&E-stained sections to establish the malignant diagnosis.
Results : Eighty-four of the 793 biopsy specimens showed AMACR immunoreactivity; nine of these (9/793, 1.1%) contained previously unrecognized small focal prostatic carcinoma (Gleason 6, N = 8; Gleason 8, N = 1). Six of nine (67%) carcinomas showed foamy/pseudohyperplastic (N = 3) or atrophic (N = 3) features. Additionally, five biopsy specimens (5/793, 0.6%) with positive AMACR staining that did not meet the criteria for prostatic cancer on the original H&E slides were considered to be atypia.
Conclusions : In this study, we found a 1.1% false-negative rate for carcinoma on routine H&E-stained sections. AMACR immunohistochemical staining has shown the ability to improve detection of small focal prostatic carcinoma that could be missed by conventional histological examination.