Utility of PTEN and ERG immunostaining for distinguishing high-grade PIN from Intraductal Carcinoma of the Prostate on Needle Biopsy

Carlos L. Morais, Jeong S. Han, Jennifer Gordetsky, Michael S. Nagar, Ann E. Anderson, Stephen Lee, Jessica L. Hicks, Ming Zhou, Cristina Magi-Galluzzi, Rajal B. Shah, Jonathan Ira Epstein, Angelo Michael Demarzo, Tamara Lotan

Research output: Contribution to journalArticle

Abstract

Intraductal carcinoma of the prostate and high-grade prostatic intraepithelial neoplasia (PIN) have markedly different implications for patient care but can be difficult to distinguish in needle biopsies. In radical prostatectomies, we demonstrated that PTEN and ERG immunostaining may be helpful to resolve this differential diagnosis. Here, we tested whether these markers are diagnostically useful in the needle biopsy setting. Separate or combined immunostains were applied to biopsies containing morphologically identified intraductal carcinoma, PIN, or borderline intraductal proliferations more concerning than PIN but falling short of morphologic criteria for intraductal carcinoma. Intraductal carcinoma occurring with concurrent invasive tumor showed the highest rate of PTEN loss, with 76% (38/50) lacking PTEN and 58% (29/50) expressing ERG. Of biopsies containing isolated intraductal carcinoma, 61% (20/33) showed PTEN loss and 30% (10/33) expressed ERG. Of the borderline intraductal proliferations, 52% (11/21) showed PTEN loss and 27% (4/15) expressed ERG. Of the borderline cases with PTEN loss, 64% (7/11) had carcinoma in a subsequent needle biopsy specimen, compared with 50% (5/10) of PTEN-intact cases. In contrast, none of the PIN cases showed PTEN loss or ERG expression (0/19). On needle biopsy, PTEN loss is common in morphologically identified intraductal carcinoma yet is very rare in high-grade PIN. Borderline intraductal proliferations, especially those with PTEN loss, have a high rate of carcinoma on resampling. If confirmed in larger prospective studies, these results suggest that PTEN and ERG immunostaining may provide a useful ancillary assay to distinguish intraductal carcinoma from high-grade PIN in this setting.

Original languageEnglish (US)
Pages (from-to)169-178
Number of pages10
JournalAmerican Journal of Surgical Pathology
Volume39
Issue number2
DOIs
StatePublished - Feb 2 2015

Fingerprint

Prostatic Intraepithelial Neoplasia
Carcinoma, Intraductal, Noninfiltrating
Needle Biopsy
Prostate
Carcinoma
Biopsy
Prostatectomy
Patient Care
Differential Diagnosis
Prospective Studies

Keywords

  • ERG
  • intraductal carcinoma
  • prostatic carcinoma
  • prostatic intraepithelial neoplasia
  • PTEN

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Utility of PTEN and ERG immunostaining for distinguishing high-grade PIN from Intraductal Carcinoma of the Prostate on Needle Biopsy. / Morais, Carlos L.; Han, Jeong S.; Gordetsky, Jennifer; Nagar, Michael S.; Anderson, Ann E.; Lee, Stephen; Hicks, Jessica L.; Zhou, Ming; Magi-Galluzzi, Cristina; Shah, Rajal B.; Epstein, Jonathan Ira; Demarzo, Angelo Michael; Lotan, Tamara.

In: American Journal of Surgical Pathology, Vol. 39, No. 2, 02.02.2015, p. 169-178.

Research output: Contribution to journalArticle

Morais, Carlos L. ; Han, Jeong S. ; Gordetsky, Jennifer ; Nagar, Michael S. ; Anderson, Ann E. ; Lee, Stephen ; Hicks, Jessica L. ; Zhou, Ming ; Magi-Galluzzi, Cristina ; Shah, Rajal B. ; Epstein, Jonathan Ira ; Demarzo, Angelo Michael ; Lotan, Tamara. / Utility of PTEN and ERG immunostaining for distinguishing high-grade PIN from Intraductal Carcinoma of the Prostate on Needle Biopsy. In: American Journal of Surgical Pathology. 2015 ; Vol. 39, No. 2. pp. 169-178.
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abstract = "Intraductal carcinoma of the prostate and high-grade prostatic intraepithelial neoplasia (PIN) have markedly different implications for patient care but can be difficult to distinguish in needle biopsies. In radical prostatectomies, we demonstrated that PTEN and ERG immunostaining may be helpful to resolve this differential diagnosis. Here, we tested whether these markers are diagnostically useful in the needle biopsy setting. Separate or combined immunostains were applied to biopsies containing morphologically identified intraductal carcinoma, PIN, or borderline intraductal proliferations more concerning than PIN but falling short of morphologic criteria for intraductal carcinoma. Intraductal carcinoma occurring with concurrent invasive tumor showed the highest rate of PTEN loss, with 76{\%} (38/50) lacking PTEN and 58{\%} (29/50) expressing ERG. Of biopsies containing isolated intraductal carcinoma, 61{\%} (20/33) showed PTEN loss and 30{\%} (10/33) expressed ERG. Of the borderline intraductal proliferations, 52{\%} (11/21) showed PTEN loss and 27{\%} (4/15) expressed ERG. Of the borderline cases with PTEN loss, 64{\%} (7/11) had carcinoma in a subsequent needle biopsy specimen, compared with 50{\%} (5/10) of PTEN-intact cases. In contrast, none of the PIN cases showed PTEN loss or ERG expression (0/19). On needle biopsy, PTEN loss is common in morphologically identified intraductal carcinoma yet is very rare in high-grade PIN. Borderline intraductal proliferations, especially those with PTEN loss, have a high rate of carcinoma on resampling. If confirmed in larger prospective studies, these results suggest that PTEN and ERG immunostaining may provide a useful ancillary assay to distinguish intraductal carcinoma from high-grade PIN in this setting.",
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AU - Anderson, Ann E.

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