Senior Scholars Program


Patterns in immunohistochemical usage in extended core prostate biopsies: comparisons among genitourinary pathologists and nongenitourinary pathologists

UMMS Affiliation

Department of Pathology

Faculty Mentor

Christopher Owens

Publication Date


Document Type



Biopsy, Large-Core Needle; Humans; Immunohistochemistry; Male; Pathology, Clinical; Prostate; Prostatic Neoplasms; Staining and Labeling


Diagnosis | Health Services Administration | Investigative Techniques | Male Urogenital Diseases | Neoplasms | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Pathology | Surgical Procedures, Operative | Urogenital System


CONTEXT: Immunohistochemical (IHC) stains have known utility in prostate biopsies and are widely used to augment routine staining in difficult cases. Patterns in IHC utilization and differences based on pathologist training and experience is understudied in the peer-reviewed literature.

OBJECTIVES: To compare the rates of IHC usage between specialized (genitourinary; [GU]) and nonspecialized (non-GU) pathologists in extended core prostate biopsies (ECPBs) and the effects of diagnosis; and in cancer cases Gleason grade, disease extent, and perineural invasion on the rate.

DESIGN: Consecutive ECPBs from 2009-2011 were identified and billing data were used to determine the number of biopsies and IHC stains per case. Diagnoses were mapped and in cancer cases, Gleason grade, extent of disease, and perineural invasion were recorded. Pathologists were classified as GU or non-GU on the basis of training and experience.

RESULTS: A total of 618 ECPBs were included in the study. Genitourinary pathologists ordered significantly fewer IHC tests per case and per biopsy than non-GU pathologists. The rate of ordering was most disparate for biopsies of cancerous and benign lesions. For biopsies of cancerous lesions, high-grade cancer, bilateral disease, and perineural invasion decreased the rate of ordering in both groups. In cancer cases, GU pathologists ordered significantly fewer stain tests for highest Gleason grade of 3 + 3 = 6, for patients with focal disease and for patients with multiple positive bilateral cores. The effect of the various predictors on IHC ordering rates was similar in both groups.

CONCLUSIONS: Genitourinary pathologists ordered significantly fewer IHC stain tests than non-GU pathologists in ECPBs. Guidelines to define when IHC workup is necessary and not necessary may be helpful to guide workups.

DOI of Published Version



Arch Pathol Lab Med. 2013 Nov;137(11):1630-4. doi: 10.5858/arpa.2012-0517-OA. Link to article on publisher's site

Journal/Book/Conference Title

Archives of pathology and laboratory medicine


Medical student Anna Plourde participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID