Immunohistochemical staining for S100P, SMAD4, and IMP3 on cell block preparations is sensitive and highly specific for pancreatic ductal adenocarcinoma

Jacob Sweeney; Rema Rao; Elizabeth Margolskee; Abha Goyal; Jonas J Heymann; Momin T Siddiqui

doi:10.1016/j.jasc.2018.07.002

Immunohistochemical staining for S100P, SMAD4, and IMP3 on cell block preparations is sensitive and highly specific for pancreatic ductal adenocarcinoma

J Am Soc Cytopathol. 2018 Nov-Dec;7(6):318-323. doi: 10.1016/j.jasc.2018.07.002. Epub 2018 Jul 7.

Authors

Jacob Sweeney¹, Rema Rao², Elizabeth Margolskee², Abha Goyal², Jonas J Heymann², Momin T Siddiqui²

Affiliations

¹ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York. Electronic address: jas9275@nyp.org.
² Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.

PMID: 31043302
DOI: 10.1016/j.jasc.2018.07.002

Abstract

Introduction: The diagnosis of pancreatic ductal adenocarcinoma (PDA) on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) material is often challenging. An immunohistochemical (IHC) panel may help establish the diagnosis of PDA in cases limited by sample size or ambiguous cytology. S100P, IMP3, and SMAD4 are 3 IHC markers that have shown promise as individual markers for PDA that have never been tested together as a panel. In this study, we evaluated the individual and combined efficacy of S100P, IMP3, and SMAD4 for the detection of PDA.

Materials and methods: S100P, IMP3, and SMAD4 IHC staining was performed on cell blocks (CBs) procured from pancreatic EUS-FNA procedures. The cohort included CBs that were diagnostic for PDA (n = 35), suspicious but nondiagnostic for PDA (n = 2), as well as CBs with benign pancreatic ductal epithelium (n = 12) and benign reactive pancreatic ductal epithelium (n = 18). A positive result for IMP3 and S100P was defined as moderate or strong staining of >10% of ductal cells. Complete lack of SMAD4 nuclear staining was considered a positive result-any nuclear SMAD4 staining was considered a negative result.

Results: Two and 3 IHC marker panels were almost always more specific than individual IHC markers. Positivity for at least 2 of 3 IHC markers was a sensitive (91.89%) and highly specific (100%) marker of PDA.

Conclusions: The 3 IHC marker panel composed of S100P, IMP3, and SMAD4 is highly specific for PDA. Future studies should evaluate efficacy in a cohort with more atypical and suspicious cases.

Keywords: Cell block; Endoscopic ultrasound-guided fine-needle aspiration; IMP3; Immunohistochemistry; Pancreatic ductal adenocarcinoma; S100P; SMAD4.