title: Immunohistochemistry versus microsatellite instability testing in phenotyping colorectal tumors.
abstract: OBJECTIVE
  To compare microsatellite instability (MSI) testing with immunohistochemical (IHC) detection of hMLH1 and hMSH2 in colorectal cancer.
  
  
  METHODS
  Colorectal cancers from 1,144 patients were assessed for DNA mismatch repair deficiency by two methods: MSI testing and IHC detection of hMLH1 and hMSH2 gene products. High-frequency MSI (MSI-H) was defined as more than 30% instability of at least five markers; low-level MSI (MSI-L) was defined as 1% to 29% of loci unstable.
  
  
  RESULTS
  Of 1,144 tumors tested, 818 showed intact expression of hMLH1 and hMSH2. Of these, 680 were microsatellite stable (MSS), 27 were MSI-H, and 111 were MSI-L. In all, 228 tumors showed absence of hMLH1 expression and 98 showed absence of hMSH2 expression: all were MSI-H.
  
  
  CONCLUSIONS
  IHC in colorectal tumors for protein products hMLH1 and hMSH2 provides a rapid, cost-effective, sensitive (92.3%), and extremely specific (100%) method for screening for DNA mismatch repair defects. The predictive value of normal IHC for an MSS/MSI-L phenotype was 96.7%, and the predictive value of abnormal IHC was 100% for an MSI-H phenotype. Testing strategies must take into account acceptability of missing some cases of MSI-H tumors if only IHC is performed.
authors.affiliation: Department of Medical Genetics, Mayo Foundation, Rochester, MN 55905, USA. nlindor@mayo.edu
authors.forename: Noralane M
authors.initials: NM
authors.lastname: Lindor
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Burgart
authors.forename: Olga
authors.initials: O
authors.lastname: Leontovich
authors.forename: Richard M
authors.initials: RM
authors.lastname: Goldberg
authors.forename: Julie M
authors.initials: JM
authors.lastname: Cunningham
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sargent
authors.forename: Catherine
authors.initials: C
authors.lastname: Walsh-Vockley
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Petersen
authors.forename: Michael D
authors.initials: MD
authors.lastname: Walsh
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Leggett
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Young
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Barker
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Jass
authors.forename: John
authors.initials: J
authors.lastname: Hopper
authors.forename: Steve
authors.initials: S
authors.lastname: Gallinger
authors.forename: Bharati
authors.initials: B
authors.lastname: Bapat
authors.forename: Mark
authors.initials: M
authors.lastname: Redston
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Thibodeau
mesh_terms: D000368:Aged; D020137:Base Pair Mismatch / Q000235:genetics*; D015179:Colorectal Neoplasms / Q000235:genetics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D004252:DNA Mutational Analysis; D004260:DNA Repair; D004273:DNA, Neoplasm / Q000235:genetics*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics*; D008875:Middle Aged; D010641:Phenotype; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D004273:DNA, Neoplasm