Diagnostic Role of Immunohistochemistry in the Evaluation of Breast Pathology Specimens

Abstract

Context.—Immunohistochemistry plays a vital role in the evaluation of breast pathology specimens. Objective.—To discuss the role of myoepithelial cell markers in the evaluation of various breast lesions. Other markers, such as E-cadherin and those used to differentiate mammary carcinoma from metastatic tumors to the breast, and markers used in the differential diagnosis of Paget disease, are also discussed. Data Sources.—Data were obtained from review of the pertinent peer-reviewed literature. Conclusions.—Myoepithelial cell markers vary in their sensitivity and specificity, and one should be aware of the potential pitfalls in interpretation. Using panels of 2 or more myoepithelial cell markers is always recommended, either singly or in cocktail forms. Although negative E-cadherin staining supports the diagnosis of lobular origin, positive staining does not rule it out. Immunohistochemistry can be helpful in differentiating Paget disease from its mimics. Although metastatic tumors to the breast are rare, a triple-negative immunophenotype and absence of an in situ component should be a “red flag” for such possibility, especially in patients with clinical history of an extramammary malignancy.