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Year : 2019  |  Volume : 39  |  Issue : 2  |  Page : 263-269

The role and accuracy of immunohistochemistry in the preoperative staging of bladder carcinoma: a retrospective study

1 Department of Pathology, Benha University, Benha, Egypt
2 Department of Pathology, Assiut University, Assiut, Egypt

Correspondence Address:
MD Shaimaa K Dawa
Department of Pathology, Faculty of Medicine, Benha University, Benha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EGJP.EGJP_34_19

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Objective Our goal is to investigate the role and accuracy of the smooth muscle actin (SMA), vimentin, and smoothelin, and cluster of differentiation 10 (CD10) immunohistochemical (IHC) markers in discriminating between muscularis propria (MP), and muscularis mucosae, and myofibroblastic stromal reaction to avoid tumor overstaging or understaging bladder carcinoma (BC). Patients and methods This retrospective study included 30 selected cases of BC diagnosed by transurethral resection as positive for MP invasion based on hematoxylin and eosin-stained sections only. After radical cystectomy, three cases of them showed no evidence of MP invasion. We applied SMA, vimentin, smoothelin, and CD10 as differentiation IHC markers hoping to clarify MP invasion from other mimickers. Results Vimentin and smoothelin were reliable and dependable differentiation markers that could help in BC staging. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting MP invasion for the smoothelin were 94.1, 84.6, 88.8, 91.6, and 90%, respectively, and those for vimentin were 94.1, 92.3, 94.1, 92.3, and 93.3%, respectively, and were improved to 94.4, 100, 100, 92.3, and 96.7%, respectively, after combining smoothelin and vimentin results. Both SMA and CD10 could not help in differentiation between myofibroblastic and smooth muscles of both muscularis mucosae and MP. Conclusion Morphology has certainly played a fundamental role in BC staging; however, in problematic cases, we suggest smoothelin and vimentin as IHC differentiation markers that could help in BC staging on small biopsies. We encourage our colleagues to perform larger scale prospective studies on transurethral resection specimens applying our recommended IHC panel to assess their potential role in BC staging on such small biopsies.

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