A Multicenter Study Directly Comparing the Diagnostic Accuracy of Gene Expression Profiling and Immunohistochemistry for Primary Site Identification in Metastatic Tumors

Handorf, Charles R.; Kulkarni, Anand; Grenert, James P.; Weiss, Lawrence M.; Rogers, William M.; Kim, Oliver S.; Monzon, Federico A.; Halks-Miller, Meredith; Anderson, Glenda G.; Walker, Michael G.; Pillai, Raji; Henner, W. David

doi:10.1097/pas.0b013e31828309c4

Cited by 94 publications

(69 citation statements)

References 23 publications

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“…Consistent with previous studies (33)(34)(35), IHC screening was able to postulate probable primary sites in 59% (26/44) of confirmed CUP cases. Interestingly, the median survival of confirmed CUP patients with no probable primary site was higher than those with probable primary sites (figure 2).…”

Section: Resultssupporting

confidence: 78%

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Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

Das

Gilani

2015

Forum of Clinical Oncology

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© De Gruyter Open Keywords: Cancer of Unknown Primary • Immunohistochemistry • Prognosis • Prognostic factorCancer centre, University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, UK ST4 6QG Tel: + 44 (0)1782 715444 Joyutpal Das* and Shahid Gilani # With the development of site-specific cancer therapy, identifying the primary origin allows the oncologist to personalise therapy for patients with the cancer of unknown primaries (CUPs). At present, immunohistochemistry (IHC) screening is the standard method used to postulate the primary site in CUP. In this retrospective study, we evaluated the prognostic benefit of identifying the primary site in CUP. All 84 patients who presented with suspected CUPs to the Royal Stoke University Hospital between 2011 and 2012, were included in our study. Forty-eight percent (40/84) of these patients were unable to undergo necessary investigations to identify primary sites because of poor performance status. IHC screening was able to postulate the primary site in 59% (26/44) of the remaining confirmed CUP patients. Therefore, the primary site was not identified in a significant proportion of suspected CUP patients. The median survival of confirmed CUP patients with probable primary sites was 2.0 months (95% confidence interval (CI): 1.2 to 2.9 months), whereas the median survival of confirmed CUP patients with no probable primary site was 4.1 months (95% CI: 1.5 to 9.7 months). This difference in survival time was statistically significant. In addition, using the Cox regression model we found that confirmed CUP patients with primary sites had prognostically unfavourable diseases with a shorter median survival, regardless of the age of disease onset, gender, sites of metastases or number of metastases. One approach to improve the survival would be to start systemic therapy at the earliest possible opportunity rather than waiting for all investigation results such as IHC.

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Section: Resultssupporting

confidence: 78%

“…The remaining half of our CUP patients underwent extensive investigations and primary sites were postulated in only 59% of those cases. In previous studies, IHC had similar rate of success in postulating the primary site (34,35). Therefore, the primary site could not be identified in a significant proportion of our CUP patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

Das

Gilani

2015

Forum of Clinical Oncology

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“…The Handorf study 29 also showed that performing additional rounds of IHC testing after a first round generally failed to provide additional diagnostic information. The panel thus recommends that only one round of staining (8-10 stains) be performed when IHC is used.…”

Section: Molecular Profilingmentioning

confidence: 99%

“…In a recent, blinded, multicenter study by Handorf et al, 29 the diagnostic accuracy of the 1550-gene GEP assay was compared with that of IHC staining in a set of metastases from known primaries. The results indicated that the accuracies were similar, with 89% accuracy for GEP and 83% accuracy for IHC (P=.013).…”

Section: Ihc Vs Gepmentioning

confidence: 99%

Occult Primary, Version 3.2014

Ettinger

Handorf

Agulnik³

et al. 2014

J Natl Compr Canc Netw

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The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation. (J Natl Compr Canc Netw 2014;12:969-974) Occult Primary, Version 3.2014 CE Authors:Deborah J. Moonan, RN, BSN, Director, Continuing Education & Grants, NCCN, has disclosed that she has no relevant financial relationships. Ann Gianola, MA, Manager, Continuing Education & Grants, NCCN, has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information Operations, NCCN, has disclosed that she has no relevant financial relationships. Individuals Who Provided Content Development and/or Authorship Assistance:David S. Ettinger, MD, panel chair, has disclosed that he has no relevant financial relationships. Charles R. Handorf, MD, PhD, panel vice-chair, has disclosed that he has no relevant financial relationships. Mary Anne Bergman, Guidelines Coordinator, has disclosed that she has no relevant financial relationships. Deborah A. Freedman-Cass, PhD, Oncology Scientist/Senior Medical Writer, has disclosed that she has no relevant financial relationships.

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“…226 Pathway Diagnostics (now defunct) also reported high diagnostic accuracy in identification of tumors of uncertain origin using microarray methodology. 227 …”

Section: Molecular Profiling For Identificationmentioning

confidence: 99%

Immunohistochemistry in Undifferentiated Neoplasm/Tumor of Uncertain Origin

Lin

Liu

2014

Archives of Pathology &Amp; Laboratory Medicine

108

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Context Immunohistochemistry has become an indispensable ancillary study in the identification and classification of undifferentiated neoplasms/tumors of uncertain origin. The diagnostic accuracy has significantly improved because of the continuous discoveries of tissue-specific biomarkers and the development of effective immunohistochemical panels. Objectives To identify and classify undifferentiated neoplasms/tumors of uncertain origin by immunohistochemistry. Data Sources Literature review and authors' research data and personal practice experience were used. Conclusions To better guide therapeutic decisions and predict prognostic outcomes, it is crucial to differentiate the specific lineage of an undifferentiated neoplasm. Application of appropriate immunohistochemical panels enables the accurate classification of most undifferentiated neoplasms. Knowing the utilities and pitfalls of each tissue-specific biomarker is essential for avoiding potential diagnostic errors because an absolutely tissue-specific biomarker is exceptionally rare. We review frequently used tissue-specific biomarkers, provide effective panels, and recommend diagnostic algorithms as a standard approach to undifferentiated neoplasms.

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A Multicenter Study Directly Comparing the Diagnostic Accuracy of Gene Expression Profiling and Immunohistochemistry for Primary Site Identification in Metastatic Tumors

Cited by 94 publications

References 23 publications

Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

Occult Primary, Version 3.2014

Immunohistochemistry in Undifferentiated Neoplasm/Tumor of Uncertain Origin

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