[Histonet] RE: Cytokeratin AE1/AE3

[Cartun, Richard]

Reference:  Weaver DL, et al.:  Effect of occult metastases on survival in node-negative breast cancer.  NEJM 2011;364:412-421.  A study funded by the National Cancer Institute (Clinical Trials).

Conclusion - "These data do not indicate a clinical benefit of additional evaluation, including immunohistochemical analysis, of initially negative sentinel nodes in patients with breast cancer.

Also, from an NSABP study:  Role of IHC in invasive lobular carcinoma - Although routine IHC staining with cytokeratin is not indicated for most breast cancers, it can be helpful for examination of the sentinel nodes in patients with invasive lobular carcinoma since the morphology of lobular cancer can be difficult to detect on H&E of axillary lymph nodes [91,92]. In general, IHC should be used to definitively diagnose an area that is suspicious for, but not diagnostic of, lymph node metastases on H&E rather than as a routine method of evaluating nodes in cases of invasive lobular cancer.

I believe most major cancer centers have stopped doing cytokeratin IHC on sentinel nodes for most breast cancer specimens.  I know that we have.

Richard

Richard W. Cartun, MS, PhD
Director, Histology & Immunopathology
Director, Biospecimen Collection Programs
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596 Office
(860) 545-2204 Fax
richard.cartun <@t> hhchealth.org


-----Original Message-----
From: Rathborne, Toni [mailto:Toni.Rathborne <@t> rwjuh.edu] 
Sent: Thursday, July 10, 2014 4:49 PM
To: Cartun, Richard; Burnett, Brandy; 'histonet <@t> lists.utsouthwestern.edu'
Subject: RE: Cytokeratin AE1/AE3

Would you share the source for the  sentinel lymph node recommendation mentioned? Although I just did a quick search, I didn't see anything on the CAP website.

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Cartun, Richard
Sent: Thursday, July 10, 2014 4:08 PM
To: Burnett, Brandy; 'histonet <@t> lists.utsouthwestern.edu'
Subject: [Histonet] RE: Cytokeratin AE1/AE3

"Extra-follicular reticulm cells" contain cytokeratin and will label with antibodies to low molecular weight cytokeratin.  Could that be what you are seeing?

Reference:  Linden MD and Zarbo RJ:  Cytokeratin immunostaining patterns of benign, reactive lymph nodes:  applications for the evaluation of sentinel lymph node specimen.  Appl Immunohistochem Mol Morphol 2001;9(4):297-301.

On another note,  the recommendation now is to not do CK IHC on sentinel lymph nodes (except for rare cases).  Lymph node involvement should be based on H&E; not IHC.

Richard

Richard W. Cartun, MS, PhD
Director, Histology & Immunopathology
Director, Biospecimen Collection Programs Assistant Director, Anatomic Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596 Office
(860) 545-2204 Fax
richard.cartun <@t> hhchealth.org


-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Burnett, Brandy
Sent: Thursday, July 10, 2014 12:08 PM
To: 'histonet <@t> lists.utsouthwestern.edu'
Subject: [Histonet] Cytokeratin AE1/AE3

Hi Histonetters,

I just came across a thread regarding issues with Cytokeratin AE1/AE3 from DAKO. I am having the same issues with our New protocol using HIER on the Link-48 in which sentinel lymph nodes from breast cases are staining non-specifically "in-between the cells".
We never had this issue before on our old Autostainer plus, however, we were using only enzyme pre-treatment on it before staining.
I was wondering if anyone else has come across this, and if they have fixed it?

Thank you,

Brandy Burnett, HTL
Cape Cod Hospital

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