Double Immunohistochemical Staining With MUC4/p53 Is Useful in the Distinction of Pancreatic Adenocarcinoma From Chronic Pancreatitis: A Tissue Microarray-Based Study

Abstract

Abstract Context.—Immunohistochemical stains have been used for the distinction of pancreatic adenocarcinoma from chronic pancreatitis. Objective.—To determine if a double stain for MUC/p53 improved specificity and sensitivity for distinction of pancreatic andenocarcinoma from chronic pancreatitis by comparing maspin, mucin 4 (MUC4), p53, Smad4, and the double stain MUC4/p53. Design.—Seventy-four pancreatic adenocarcinomas and 19 chronic pancreatitis cases were retrieved from archival files. Tissue cores were arrayed to create a tissue microarray of 2-mm cores. Sections were stained with antibodies against maspin, MUC4, p53, and Smad4. Additionally, a 2-color, double stain for MUC4 and p53 was developed and evaluated. Five percent or greater staining in either of the cores was considered positive. Intensity (0, 1, 2) and extent (%) of tumor cells staining was also determined. Results.—The sensitivity for distinction of pancreatic adenocarcinoma from chronic pancreatitis with maspin, MUC4, p53, and Smad4 was 90%, 77%, 60%, and 63%, respectively; the specificity was 67%, 78%, 88%, and 88%, respectively. When MUC4 and p53 were combined in a double stain, and positive staining for either considered a positive result, the sensitivity increased to 96% but specificity was 73%. When immunoreactivity for both antibodies was necessary for a positive result, sensitivity fell to 39% but specificity was 100%. No correlation was found between intensity or extent of staining with any of the individual stains and tumor differentiation. Conclusion.—The double immunohistochemical stain for MUC4/p53 can be a useful diagnostic tool in conjunction with the hematoxylin-eosin–stained section for pancreatic adenocarcinoma, particularly when limited tumor is available for multiple stains.