title: Use of immunohistochemistry in routine workup of prostate needle biopsies: a tertiary academic institution experience.
abstract: BACKGROUND
  Diagnostic use of immunohistochemistry has been extensively studied in prostate needle biopsy, but its use in routine practice and the quality assurance and associated cost have not been previously addressed.
  
  
  OBJECTIVE
  To examine the routine use of immunohistochemistry in prostate biopsies in a tertiary academic institution.
  
  
  METHODS
  We reviewed reports of 748 consecutive prostate biopsies and we evaluated the turnaround times, the final diagnosis on individual specimens, the intradepartmental consultation rates, and the associated costs.
  
  
  RESULTS
  Immunohistochemistry evaluation was required for 39.4% of biopsies and 12% of blocks (average 1.8 blocks/case). The biopsies with immunohistochemistry were signed out 1.7 workdays later (8.6 versus 6.9 days). The diagnostic breakdown for individual blocks evaluated by immunohistochemistry was Cancer 47.7%; Atypical, Suspicious 10.8%; Small Atypical Glands Adjacent to High-Grade Prostatic Intraepithelial Neoplasia 6.9%; High-Grade Prostatic Intraepithelial Neoplasia 12.4%; and Benign 22.2%. Diagnoses of Cancer or Atypical, Suspicious (Atypical, Suspicious + Small Atypical Glands Adjacent to High-Grade Prostatic Intraepithelial Neoplasia) were rendered in 65.4% of individual blocks assessed by immunohistochemistry. Immunohistochemistry aided in establishing limited cancer (≤10% of core) in 69.3% of cases and in 74% of single-core-positive biopsies. Departmental consultation was performed in 18.3% of biopsies and immunohistochemistry was used in 68% of these cases. Both immunohistochemistry and consultation were performed in 55.8% of Atypical, Suspicious cases. The average immunohistochemistry cost per biopsy was $22.34 and the estimated annual cost for prostate biopsy immunohistochemistry in our laboratory was $33 420.64.
  
  
  CONCLUSIONS
  Immunohistochemistry is frequently used in our prostate biopsy practice to establish or confirm a limited Cancer diagnosis, to better resolve diagnostic ambiguity, or for quality assurance. The data provided herein can be used for comparisons with other prostate biopsy practices.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services and Rockyview General Hospital, Calgary, Alberta, Canada T2V 1P9.
authors.forename: Kristalee
authors.initials: K
authors.lastname: Watson
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.forename: Asli
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Bismar
authors.forename: Kiril
authors.initials: K
authors.lastname: Trpkov
mesh_terms: D000046:Academic Medical Centers; D000230:Adenocarcinoma / Q000378:metabolism* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001707:Biopsy, Needle / Q000191:economics; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000378:metabolism* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000378:metabolism* / Q000473:pathology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor