title: Utility of ProEx C in the histologic evaluation of the neoplastic and nonneoplastic urothelial lesions.
abstract: ProEx C is an antibody cocktail targeting the expression of topoisomerase IIα and minichromosome maintenance protein 2. ProEx C staining is being used mainly to assist in diagnoses of dysplasia in gynecological specimens. This study was designed to determine the utility of ProEx C in assessing the urothelial lesions. Sixty-four patient specimens were divided into 5 groups: group I, 22 benign; group II, 13 low-grade noninvasive papillary urothelial carcinoma; group III, 10 high-grade urothelial carcinoma in situ (flat lesion); and group IV, 19 high-grade noninvasive papillary and invasive urothelial carcinomas. ProEx C reactions were scored in basal, parabasal, intermediate, and superficial cell layers. A sample was recorded as positive when nuclear staining was seen in the cells of the intermediate and/or superficial layers. Of 22 cases in group I, 21 were negative for ProEx C with a specificity of 95%. Of 13 cases in group II, 11 had positive results with sensitivity of 85%. All cases in groups III and IV had positive staining pattern with ProEx C with a sensitivity of 100%. In this study, ProEx C stain had an overall 95% sensitivity and specificity with positive and negative predictive values of 98% and 91%, respectively, for detection of urothelial carcinoma. We conclude that ProEx C is effective in differentiating carcinoma in situ and benign urothelial lesions. It also resolves issues in low- versus high-grade papillary urothelial carcinomas. To our knowledge, this is the first publication on the diagnostic application of ProEx C in histopathology of the urothelial lesions.
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095. Electronic address: nmoatamed@mednet.ucla.edu.
authors.forename: Neda A
authors.initials: NA
authors.lastname: Moatamed
authors.forename: Maria E
authors.initials: ME
authors.lastname: Vergara-Lluri
authors.forename: David
authors.initials: D
authors.lastname: Lu
authors.forename: Sophia K
authors.initials: SK
authors.lastname: Apple
authors.forename: Susan
authors.initials: S
authors.lastname: Kerkoutian
authors.forename: Jian-Yu
authors.initials: JY
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001706:Biopsy; D002278:Carcinoma in Situ / Q000378:metabolism / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000378:metabolism / Q000473:pathology*; D004250:DNA Topoisomerases, Type II / Q000378:metabolism; D004268:DNA-Binding Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D064111:Minichromosome Maintenance Complex Component 2 / Q000378:metabolism; D011237:Predictive Value of Tests; D011247:Pregnancy; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D014516:Ureteral Neoplasms / Q000473:pathology; D001743:Urinary Bladder / Q000378:metabolism / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000378:metabolism / Q000473:pathology*; D019459:Urothelium / Q000378:metabolism / Q000473:pathology*; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D011933:Reagent Kits, Diagnostic; C084859:MCM2 protein, human; D064111:Minichromosome Maintenance Complex Component 2; D004250:DNA Topoisomerases, Type II
keywords: Carcinoma; Histology; ProEx C; Reactive; Urothelium