Transcription factor immunohistochemistry in the diagnosis of pituitary tumours

in European Journal of Endocrinology
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  • 1 Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia
  • 2 Garvan Institute of Medical Research, Sydney, New South Wales, Australia
  • 3 St Vincent’s Clinical School, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
  • 4 Department of Anatomical Pathology and Cytopathology, St Vincent’s Pathology, Sydney, New South Wales, Australia
  • 5 Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
  • 6 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  • 7 Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • 8 Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

Correspondence should be addressed to N F Lenders Email n.lenders@garvan.org.au

Objective

The clinical utility and prognostic value of WHO 2017 lineage-based classification of pituitary tumours have not been assessed. This study aimed to (1) determine the clinical utility of transcription factor analysis for classification of pituitary tumours and (2) determine the prognostic value of improved lineage-based classification of pituitary tumours.

Methods

This was a retrospective evaluation of patients who underwent surgical resection of pituitary tumours at St Vincent’s Public and Private Hospitals, Sydney, Australia between 1990 and 2016. Included patients were at least 18 years of age and had complete histopathological data, forming the 'histological cohort'. Patients with at least 12 months of post-surgical follow-up were included in the subgroup 'clinical cohort'. The diagnostic efficacy of transcription factor immunohistochemistry in conjunction with hormone immunohistochemistry was compared with hormone immunohistochemistry alone. The prognostic value of identifying 'higher-risk' histological subtypes was assessed.

Results

There were 171 patient tumour samples analyzed in the histological cohort. Of these, there were 95 patients forming the clinical cohort. Subtype diagnosis was changed in 20/171 (12%) of tumours. Within the clinical cohort, there were 21/95 (22%) patients identified with higher-risk histological subtype tumours. These were associated with tumour invasiveness (P = 0.050), early recurrence (12–24 months, P = 0.013), shorter median time to recurrence (49 (IQR: 22.5–73.0) vs 15 (IQR: 12.0–25.0) months, P = 0.005) and reduced recurrence-free survival (P = 0.031).

Conclusions

Application of transcription factor analysis, in addition to hormone immunohistochemistry, allows for refined pituitary tumour classification and may facilitate an improved approach to prognostication.

 

     European Society of Endocrinology

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