Role of Immunohistochemistry in Surgical Pathology Diagnostics

Samuel Carolyn^*
*Correspondence: Samuel Carolyn, Department of Pathology, Tzu Chi University, Taiwan, Email:

Introduction

Immunohistochemistry (IHC) has emerged as an indispensable tool in
surgical pathology diagnostics, bridging the gap between morphology and
molecular biology. By enabling the visualization of specific antigens within
tissues using antigen-antibody interactions, IHC provides critical information
that augments traditional histological methods. Its applications span across
diagnostic, prognostic and predictive aspects of patient care, making it an
integral component of modern pathology. The foundation of IHC lies in its
ability to detect proteins within their histological context, allowing pathologists
to identify cellular origins and characterize the molecular profile of lesions. This
is particularly significant in cases where morphology alone is insufficient to
establish a definitive diagnosis. For instance, differentiating between benign
and malignant lesions, or identifying the primary site of metastatic tumors,
often relies heavily on IHC markers. Specific markers, such as cytokeratins,
S-100, CD markers and hormonal receptors, have been extensively utilized to
classify tumors and delineate their lineages [1,2].

Description

In surgical pathology, IHC has revolutionized the diagnostic process for a
wide range of malignancies. One notable example is its role in the subtyping
of lymphomas. Morphological features of lymphomas can be remarkably
similar, yet the therapeutic implications differ substantially. IHC markers
such as CD20, CD3 and CD30 are crucial in distinguishing between various
lymphoma subtypes, thus guiding appropriate treatment strategies. Similarly,
in carcinomas, the expression of markers like HER2/neu, ER and PR provides
not only diagnostic insights but also prognostic and therapeutic information,
especially in breast cancer management.

The application of IHC extends beyond oncology, as it aids in diagnosing infectious diseases, neurodegenerative disorders and inflammatory conditions. For instance, detecting pathogens such as Helicobacter pylori in gastric biopsies or identifying amyloid deposits in neurodegenerative diseases exemplifies its utility in non-neoplastic conditions. Additionally, IHC plays a role in confirming diagnoses of autoimmune conditions by detecting specific autoantibodies in tissue samples Advances in IHC technology have further enhanced its diagnostic capabilities. The development of multiplex IHC, which allows simultaneous detection of multiple markers, has significantly improved diagnostic accuracy and efficiency. Coupled with digital pathology and image analysis, multiplex IHC enables quantitative assessment and minimizes interobserver variability, thus standardizing diagnostic practices. Moreover, the integration of IHC with molecular techniques such as Fluorescence in Situ Hybridization (FISH) and Next-Generation Sequencing (NGS) has opened new avenues for precision medicine. This combinatorial approach facilitates comprehensive tumor profiling, ensuring that patients receive tailored therapies based on their tumorâ??s molecular characteristics. Quality control is paramount in IHC to ensure reliable and reproducible results. Pre-analytical variables, including tissue fixation and antigen retrieval, significantly influence staining outcomes. Standardization of protocols, alongside rigorous quality assurance measures, is essential to maintain the diagnostic utility of IHC. Continuous education and training of pathologists and laboratory personnel further contribute to optimizing the use of IHC in clinical practice. Despite its transformative impact, IHC is not without limitations. Interpretation of IHC results can be subjective, requiring expertise and experience to distinguish true positivity from background staining or artifacts. Additionally, the cost of antibodies and the need for specialized equipment pose challenges, particularly in resource-limited settings. Efforts to address these limitations include the development of cost-effective reagents and the promotion of collaborative initiatives to share resources and expertise.

Conclusion

Immunohistochemistry has established itself as a cornerstone in
surgical pathology diagnostics. Its ability to provide detailed molecular
insights has transformed the diagnostic landscape, enabling accurate
classification, prognostication and therapeutic decision-making. As
advancements continue to refine its applications, IHC will undoubtedly
remain at the forefront of diagnostic pathology, ensuring better outcomes
for patients through precision medicine.

References

1. Montal, Robert, Daniela Sia, Carla Montironi and Wei Q. Leow, et al. "Molecular classification and therapeutic targets in extrahepatic cholangiocarcinoma." J Hepatol 73 (2020): 315-327.

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2. Silver, Robert M. and D. Ware Branch. "Placenta accreta spectrum." N Engl J Med 378 (2018): 1529-1536.

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