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Abstracts & Presentations

Nathan Acott (view biography)
Technical test approach: the analytical phase

Yvette Beaber (view biography)
Cytokeratins in common practice: antibody selection, protocols
and controls

Thomas Brenn (view biography)
Is there a role for immunohistochemistry in the diagnosis of skin adnexal tumors
Update on the use of immunohistochemistry for the diagnosis of melanocytic tumors
Diagnostic challenges in vascular skin tumors

Eric Burks (view biography)
Kappa and Lambda light chain assessment: Fit-for-purpose assay development
Multiplex IHC as a means to aide in the assessment of minimal residual disease (MRD)
for plasma cell neoplasms.

Hazel Chambers-Smith (view biography)
The role of immunohistochemistry in the diagnosis of paediatric brain tumours

Bron Christiansen (view biography)
Technical test approach: the pre-analytical phase

David Gan (view biography)
MOCKTALES: A Mock RCPAQAP IHC Assessment

Zenobia Haffajee (view biography)
Keeping ABREAST of your EQA results. Breast Markers Review – An RCPAQAP update.

Emiel Janssen (view biography)
Molecular biomarkers in endometrial hyperplasia
IHC and molecular diagnostics in non-small cell lung carcinoma

Søren Nielsen (view biography)
NordiQC – external quality assessment update
The tissue tool box: the journey from antibody to IHC assay
PD-L1 immunohistochemistry: NordiQC companion module

Julia Pagliuso (view biography)
RCPA-QAP-external quality assessment update

Mogens Vyberg (view biography)
The immunohistochemistry of the unknown primary cancer: approach, panels and NordiQC data
The role of immunohistochemistry in gastrointestinal cancer classification: approach, panels and NordiQC data
Markers for classification of lung cancer

 

Complete abstract content below

Technical test approach: the analytical phase
Nathan Acott (view biography)
PathWest Laboratory Medicine – Nedlands, WA, Australia

The only phase of Immunohistochemistry that the IHC lab has real control over is the analytical phase, in particular the IHC protocol part of the analytical phase. The IHC protocol covers dewaxing the slides through to cover slipping. The decisions made by the IHC laboratory impact greatly on patient outcomes and treatment. This talk will focus on protocol development and implementation and types of assays, as well as quality assurance aspects of the analytical phase including control material.
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MOCKTALES: A Mock RCPAQAP IHC Assessment
David Gan (view biography)
Supervisor of the Special Stains area in Anatomical Pathology
QML Pathology

As a participant in the RCPAQAP IHC module, it can be difficult to understand what is involved in assessing your slides. When a result comes back to the laboratory, opinions may range from “I totally agree with the expert comments and score”, to “Were they looking at the right slide?”
This presentation will attempt to clear up a few myths about assessments as well as include the audience in a mock assessment to get a better understanding of the process.
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Keeping ABREAST of your EQA results. Breast Markers Review – An RCPAQAP update.
Zenobia Haffajee (view biography)
Senior Scientist
Royal College of Pathologists of Australasia
Quality Assurance Program, Anatomical Pathology
St Leonards, NSW, Australia

RCPAQAP provides EQA assessment for proficiency testing for Immunohistochemistry (IHC) and bright field in situ hybridization (ISH) techniques for the detection of breast tumour markers. This specific EQA determines the quality of Oestrogen (ER), Progesterone (PR), HER2 IHC and HER2 ISH staining on formalin fixed paraffin-embedded tumour sections.

The Breast markers EQA pilot was implemented in 2002. This presentation is an overview of data collated over a period of 17 years and highlights the survey results and participant performance.

In keeping with the updated recommended ASCO/CAP guidelines from the RCPA, laboratories are recommended to ensure that their methods area validated against a reference method and that the assays performance is continuously monitored to identify any potential issues. This may have the potential to affect patient treatment.
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RCPA-QAP-external quality assessment update
Julia Pagliuso (view biography)
The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Anatomical Pathology,
St Leonards, NSW, 2065,
Australia

The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) provides world-class, peer-reviewed External Quality Assurance (EQA) programs and continuing professional education. Our programs are offered in Australia and internationally in over 80 countries. Our strength lies in the expertise and support provided by an extensive advisory network consisting of pathologists and scientific staff from Australia and internationally.

The RCPAQAP has undergone a number of changes over the last few years and is continuing to evolve. These changes will be communicated, along with a summary of the future directions and projects for the Anatomical Pathology discipline.

Changes discussed will include:

  • Informatics – new myQAP portal
  • Changes to programs –HER2 ISH (Bright field)
  • Online product catalogue – advertising of antibodies/stains for next year
  • New initiatives – PD-L1 NSCLC Interpretation, PDL-1 triple negative breast cancer, FISH

RCPAQAP is committed to provide an efficient and customer focused service to participants and feedback is welcome. RCPAQAP staff will be available to answer any questions during breaks.
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Is there a role for immunohistochemistry in the diagnosis of skin adnexal tumors
Thomas Brenn (view biography)
Professor
Cumming School of Medicine, University of Calgary
Calgary, Canada

The diagnosis of skin adnexal tumors is notoriously difficult due to the rarity of these tumors and their broad morphologic spectrum. The correct diagnosis is often challenging as the criteria for malignancy are poorly defined and entity specific. Immunohistochemistry plays a limited role in the diagnosis of these tumors at present. This talk provides a brief overview of skin adnexal tumors with basaloid features and their differential diagnosis with emphasis on the use and appropriateness of immunohistochemistry in this setting.
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Update on the use of immunohistochemistry for the diagnosis of melanocytic tumors
Thomas Brenn (view biography)
Professor
Cumming School of Medicine, University of Calgary
Calgary, Canada

The diagnosis of melanocytic tumors poses on of the biggest challenges in dermatopathology. They are common and the vast majority are benign. Recognition if melanocytic tumors with potential for aggressive behavior may be challenging both clinically and histologically. This talk will concentrate on a brief discussion of markers of melanocytic differentiation and those that may aid in separating nevi form melanoma. Furthermore, significant progress has been made in our understanding of the molecular events underlying Spitzoid melanocytic tumors, deep penetrating nevi and blue nevi. The usefulness of immunohistochemical markers in this setting will also be discussed.
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Diagnostic challenges in vascular skin tumors
Thomas Brenn (view biography)
Professor
Cumming School of Medicine, University of Calgary
Calgary, Canada

Vascular tumors are frequently encountered in the skin. The show a wide morphologic spectrum with biologic potential ranging from entirely benign or reactive to outright malignant with high mortality rates. While the majority of cutaneous vascular tumors is benign identification of those with aggressive behavior may be challenging. This talk focuses on the spectrum of cutaneous vascular tumors with epithelioid cell morphology and includes a discussion of epithelioid hemangioma, epithelioid angiomatous nodule, epithelioid hemangioma and epithelioid angiosarcoma. The emphasis is on differential diagnosis and appropriate use of immunohistochemistry.
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Technical test approach: the pre-analytical phase
Bron Christiansen (view biography)
The Royal Children’s Hospital
Parkville, VIC, Australia

There are many things prior to performing our IHC that can have an impact on getting the right results for our patients. This session will discuss some obvious, and some not so obvious, steps we need to take to ensure the quality of our testing.
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Technical test approach: the pre-analytical phase
Emiel Janssen (view biography)
Stavanger University and Stavanger University Hospital
Department of Pathology
Stavanger, Norway

Endometrial hyperplasia (EH) is an excessive proliferation of endometrial glands that leads to a higher gland/stroma ratio, compared with normal endometrium. EH is much more frequent than endometrial cancer; 5-10% of untreated EHs progress to endometrial endometrioid adenocarcinoma. EH can be evaluated by the 2003 World Health Organization (WHO) or the more current approach, endometrial intraepithelial neoplasia (EIN) system. The 2003 WHOclassification is based on glandular crowding and cytologic atypia that resulted in 4 subgroups with increasing cancer risk. Despite its worldwide use, the inter- and intraobserver reproducibility of cytologic atypia (the most important of the 2 prognostic WHO factors) is not very good. The EIN classification distinguishes benign reactive hyperplasias (a polyclonal lesion), which is the result of excessive stimulation by estrogens, and EIN, which is a monoclonal neoplasm. The EIN classification is based on morphometric data and molecular monoclonality.
The morphometric Dscore appears to be most reproducible of all existing prognostic classifications and prognostically to be the strongest.2 However, the computerized morphometric analysis technology that is required for D-score assessment is not available widely at the moment.
Although this will most likely change with the advent of digital pathologic evaluation, it would be preferable to have strong molecular immunohistochemical outcome predictors. An historic overview on the development and background for the D.score will be provided, furthermore the role of other immunhistochemical and molecular markers that can support EIN classification will be presented.
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Technical test approach: the pre-analytical phase
Emiel Janssen (view biography)
Stavanger University and Stavanger University Hospital
Department of Pathology
Stavanger, Norway

Lung cancer is a disease with dismal prognosis. In addition it is a common disease, – implying its’ major impact on survival. For optimized treatment of lung cancer patients, an increasing number of biomarkers are being tested. In todays practice NSCLC patients are tested for treatment-predictive markers PD-L1, EGFR, AKL, BRAF and ROS1. While PD-L1 remains a protein-based analysis through IHC, the other three require (additional) molecular (DNA or RNA) analyses. Future holds the need for increasing molecular testing to identify a constantly increasing number somatic genetic alterations in driver genes. In addition to SNV and Indels, structural rearrangement in genes like ROS1, RET, ALK, BRAF and NTRK1-3 are recurrently seen in lung carcinomas, and for which targeted therapies are available. An overview on current practices and research on more immunohistochemical markers for the tumor microenvironment will be discussed.
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Technical test approach: the pre-analytical phase
Eric Burks (view biography)
Clinical Associate Professor of Pathology
Boston University School of Medicine

Assessment of kappa/lambda light chains is one of the most useful diagnostic modalities in the diagnosis of B-cell and plasma cell neoplasms. Kappa/lambda assessment by immunohistochemistry has traditionally been challenging due to high background from serum immunoglobulins enriched in certain tissue types (bone marrow and spleen). This has partially been addressed by kappa/lambda ISH assays however decalcification procedures utilized in bone and bone marrow biopsies often produces false negative/weak staining reactions with ISH. To further complicate matters, the range of expression of light chains expression varies dramatically within the spectrum of B-cell neoplasia, with highest expression observed in plasma cell neoplasms and lowest expression seen in mature B-cell neoplasms (SLL/CLL) which is typically undetectable with most immunohistochemical protocols. For this reason, flow cytometry of fresh tissue is often mandatory for diagnosis but may be unavailable if lymphoma was not initially suspected prior to fixation. For these reasons, separately validated assays for kappa and lambda immunohistochemistry for purposes of diagnosing mature B-cell lymphomas in tissue and to assess plasma cell clonality in bone marrow biopsies will be discussed.
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Technical test approach: the pre-analytical phase
Eric Burks (view biography)
Clinical Associate Professor of Pathology
Boston University School of Medicine

Phenotypic assessment of MRD in plasma cell neoplasms is currently performed by multiparametric flow cytometry in which aberrant expression of cytoplasmic makers such as CD56 and CD117 aide in the diagnosis. In addition, a subset of plasma cell neoplasms are characterized by a translocation involving CCND1 and thus these aberrantly express nuclear cyclin D1. After treatment for plasma cell myeloma and at diagnosis of AL-amyloidosis, neoplastic plasma cells frequently number less than 5% of nucleated bone marrow cells. The ability to multiplex aberrant markers (CD56, CD117, and cyclin D1) with normal plasma cell makers (CD138 cytoplasmic or Mum-1 nuclear) offers the ability to identify small abnormal populations which can exist in a background of normal plasma cells. A comparison of the
sensitivity for dual IHC staining and optimization to match antigen intensity for matched multiparametric flow cytometry samples will be presented.
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The immunohistochemistry of the unknown primary cancer: approach, panels and NordiQC data
Mogens Vyberg (view biography)
Prof
Univ of Copenhagen Department of Pathology
Copenhagen, Denmark

Pathologists are often challenged by cancers of uncertain origin, where immunohistochemistry (IHC) is useful or even mandatory to suggest the primary site or at least narrow the possibilities.
But IHC must be planned properly in order to avoid waste of time and money. In case of an undifferentiated cancer, a panel including CD45, Pan-cytokeratin, S-100 and Vimentin antibodies will most often give valid information that allows for a secondary panel to settle a diagnosis. Based on experiences from NordiQC external quality assurance, the presentation will focus on clone selection, protocol optimization, and control selection.
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The role of immunohistochemistry in gastrointestinal cancer classification: approach, panels and NordiQC data
Mogens Vyberg (view biography)
Prof
Univ of Copenhagen Department of Pathology
Copenhagen, Denmark

Epithelial intestinal markers include CEA, CDX2, SATB2 and CAD17, neuroendocrine markers include Synaptophysin, Chromogranin and Ki67, markers for gastrointestinal stromal tumor and other mesenchymal neoplasias include CD117, DOG1, Desmin, S-100 and beta-cathenin. Predictive markers include MLH1, MSH2, MSH6 and PMS2. Based on experiences from NordiQC external quality assurance, the presentation will focus on clone selection, protocol optimization, and control selection.
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Markers for classification of lung cancer
Mogens Vyberg (view biography)
Prof
Univ of Copenhagen Department of Pathology
Copenhagen, Denmark

In the differential diagnosis of lung adenocarcinoma vs. squamous cell carcinoma, a panel of IHC markers typically comprise TTF-1, Napsin A, CK5 and p40. If a neuroendocrine neoplasia is suspected, Synaptophysin, Chromogranin and Ki67 should be included. If malignant mesothelioma is a relevant differential diagnosis, the panel may also include Calretinin, Podoplanin and Wilms’ tumour-1. Based on experiences from NordiQC external quality assurance, the presentation will focus on clone selection, protocol optimization, and control selection.
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The role of immunohistochemistry in the diagnosis of paediatric brain tumours
Hazel Chambers-Smith (view biography)
Senior Scientist
The Royal Children’s Hospital, Department of Anatomical Pathology
Parkville, VIC. Australia

Paediatric brain tumour pathology is a rapidly evolving area in Histopathology and is a distinct group from their adult counterparts. The need for integrated reporting using morphology, IHC and molecular techniques is essential for accurate diagnosis. In this talk, we will discuss several paediatric brain tumours and some uncommon antibodies that are used routinely for their diagnosis. We will also consider some technical aspects of using challenging antibodies to diagnose these tumours.
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NordiQC – external quality assessment update
Søren Nielsen (view biography)
Director
Nordi QC- Institute of Pathology
Aalborg University Hospital
Aalborg, Denmark

IHC is an increasingly important tool in diagnostic pathology and is changing from being an ancillary diagnostic technique to a more stand-alone diagnostic method, of which the results impact and determine treatment approach in the era of precision medicine. For this reason, participation in external quality programs for IHC becomes very important. The presentation will give an overview of the working principles of NordiQC, the results and observations generated and discuss future directions of IHC EQA.
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The tissue tool box: the journey from antibody to IHC assay
Søren Nielsen (view biography)
Director
Nordi QC- Institute of Pathology
Aalborg University Hospital
Aalborg, Denmark

Implementation and successful use of IHC for diagnostics rests on a careful optimization and development of the IHC method. Especially many pre-analytical and analytical parameters can influence the result and these have to be addressed and investigated in order to evaluate the robustness of a specific IHC method. In addition data on analytical sensitivity, specificity and reaction pattern must be characterized and finally identification of reliable positive and negative controls to monitor the reproducibility of the IHC method is of utmost importance. The presentation will give examples how to use tissues at the different development phases converting an antibody to a diagnostic IHC assay.
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PD-L1 immunohistochemistry: NordiQC companion module
Søren Nielsen (view biography)
Director
Nordi QC- Institute of Pathology
Aalborg University Hospital
Aalborg, Denmark

Immunotherapy has been shown to be an effective treatment of many cancers and especially in advanced non-small-cell lung cancer (NSCLC). The PD-L1 expression levels in tumors characterized by IHC may offer a selection criterion for patients to predict their immunotherapy response and overall stratification of treatment. In NSCLC, patients with high tumor PD-L1 levels (proportional score ≥ 50% for first-line therapy and ≥ 1% for second-line treatment, respectively) showed better response rates to immunotherapy and longer survival compared with conventional chemotherapy.
However to exploit the predictive value of IHC for PD-L1, the diagnostic accuracy must be very high and in 2017 NordiQC offered a new EQA module focusing on PD-L1 IHC in order to evaluate the performance of this predictive marker in diagnostic laboratories. The presentation will describe the results generated and lessons learned in the PD-L1 companion module.
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Cytokeratins in common practice: antibody selection, protocols
and controls

Yvette Beaber (view biography)
Monash Medical Centre,
Victoria, Australia

Cytokeratin immunohistochemistry encompasses a group of essential antibodies allowing for the identification of intermediate fibres in epithelial cells which are largely organ or tissue specific. This is also evident in malignant tissue as the epithelia is largely intact allowing for tumour diagnosis and characterisation. This talk will cover the cytokeratin antibodies used at Monash Health, the types of control used, sourcing tissue and recording their use.
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Last update on: 2020/02/25 18:10:13 UTC/GMT time.