Intraoperative rapid immunohistochemistry with noncontact antibody mixing for undiagnosed pulmonary tumors

Knowledge of the histologic type and primary origin of pulmonary tumors is essential when preparing a surgical strategy. Intraoperative diagnosis of hematoxylin and eosin (H&E)‐stained frozen sections is the gold standard, but reliable pathology requires time‐consuming immunohistochemistry (IHC)...

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Bibliographic Details
Published in:Cancer science 2023-02, Vol.114 (2), p.702-711
Main Authors: Imai, Kazuhiro, Nanjo, Hiroshi, Shigeeda, Wataru, Sugai, Tamotsu, Ito, Tomoo, Maniwa, Yoshimasa, Takashima, Shinogu, Saito, Hajime, Yanagawa, Naoki, Tanaka, Yugo, Doi, Takefumi, Hiroshima, Yuko, Nomura, Kyoko, Tanino, Mishie, Tanaka, Shinya, Minamiya, Yoshihiro
Format: Article
Language:English
Subjects:
alternating current field mixing
Antibodies
Antigens
Biopsy
Clinical medicine
Diagnosis
Electric fields
Feasibility studies
frozen section
Hospitals
Humans
Immunohistochemistry
Lung - pathology
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Malignancy
Metastasis
Observational studies
Original
pulmonary metastasis
Reproducibility of Results
Sample size
surgery
Thoracic surgery
Tumors
Voltage
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Summary:Knowledge of the histologic type and primary origin of pulmonary tumors is essential when preparing a surgical strategy. Intraoperative diagnosis of hematoxylin and eosin (H&E)‐stained frozen sections is the gold standard, but reliable pathology requires time‐consuming immunohistochemistry (IHC) to distinguish among histological types/organ origins and to analyze molecular status. The aim of this study was to evaluate the clinical reliability of a new rapid‐IHC technique for intraoperative diagnosis of pulmonary tumors. In total, 169 patients with undiagnosed pulmonary tumors were enrolled in a multicenter prospective observational study. At three institutes, pulmonary tumor samples were collected through core needle biopsy and/or surgery to determine surgical strategies. Using a new device for rapid IHC, we applied a high‐voltage, low‐frequency alternating current (AC) field, which mixes the available antibody as the voltage is switched on/off. Rapid IHC can provide tumor histologic type/origin diagnoses within 20 min, as opposed to the 3–6 h required for conventional IHC. No false diagnoses of malignancy were rendered in any of the cases when using simple H&E staining. With H&E staining alone, the overall definitive diagnosis rate, the rate of defined tumor origin, and the rate of determined histological type were 76.92%, 85.80%, and 90.53%, respectively. When rapid IHC was added, those rates were significantly improved to 88.76%, 94.67%, and 91.72%, respectively. By providing prompt and accurate intraoperative histological/molecular analysis, rapid IHC driven by AC mixing could serve as an effective clinical tool guiding the surgical strategy for undiagnosed pulmonary tumors. Rapid‐immunohistochemistry (IHC) with an alternating current field mixing can provide tumor intraoperative‐molecular/histological diagnosis within 20 min. The advantages of this procedure are its simplicity, high accuracy and preservation of surgical tissue for subsequent molecular assessments. Rapid‐IHC appears to be an accurate method to guide the surgical strategy for undiagnosed pulmonary tumors.
ISSN:1347-9032
1349-7006
DOI:10.1111/cas.15616