肿瘤诱导的骨软化症(TIO)是一种罕见的副肿瘤疾病,由成纤维细胞生长因子23(FGF23)过度分泌引起。FGF23免疫组织化学(IHC)被认为是确认TIO诊断的有用辅助标记。然而,它经常局部染色,限制其诊断效用。
这项工作旨在比较生长抑素受体2A(SSTR2A)和FGF23IHC对TIO的诊断性能。
我们回顾性分析了2006年7月至2020年5月期间在Severance医院诊断为TIO的患者。组织学评价采用组织评分(H评分)(表达面积比例评分[0-2]×强度评分[1-3],[total,0-6])。FGF23和SSTR2AIHC使用来自18例局部TIO患者以及9和15例骨和软组织肿瘤的非TIO对照的未染色载玻片进行,分别。SSTR2A阳性定义为细胞质,膜质,或高尔基染色超过1%的肿瘤细胞,和阴性为非特异性核染色。FGF23阳性被定义为在超过1%的肿瘤区域中的细胞质表达,阴性被定义为非特异性核染色。
在接受68Ga-DOTATOC扫描的15例患者中,有14例成功检测到可疑病变。在所有TIO患者中鉴定出弥漫性细胞质SSTR2A表达,在15个对照中的12个中鉴定出局灶性弱核染色。在18个TIO患者中的11个中鉴定了FGF23细胞质表达,在9个对照中的9个中鉴定了弥漫性核染色。SSTR2A的H评分高于FGF23IHC(中位数[四分位距]:6[6-6]vs1[0-2],P<.001)。
具有H分数量化的SSTR2AIHC可能更敏感,辅助诊断工具而不是FGF23IHC用于TIO诊断。
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder caused by excessive fibroblast growth factor 23 (FGF23) secretion. FGF23 immunohistochemistry (IHC) is proposed as a useful adjunctive marker to confirm TIO diagnosis. However, it often stains focally, limiting its diagnostic utility.
This work aimed to compare the diagnostic performance between somatostatin receptor 2A (
SSTR2A) and FGF23 IHC for TIO.
We retrospectively reviewed TIO-diagnosed patients in Severance Hospital between July 2006 and May 2020. Histologic evaluation was performed using histoscore (H score) (expression area proportion score [0-2] × intensity score [1-3], [total, 0-6]). FGF23 and
SSTR2A IHC were performed using unstained slides from 18 localized TIO patients and 9 and 15 non-TIO controls with bone and soft-tissue tumors, respectively.
SSTR2A positivity was defined as cytoplasmic, membranous, or Golgi staining in more than 1% of tumor cells, and negativity as nonspecific nuclear staining. FGF23 positivity was defined as cytoplasmic expression in more than 1% of the tumor area and negativity as nonspecific nuclear staining.
Suspicious lesions were successfully detected in 14 of 15 patients who underwent 68Ga-DOTATOC scans. Diffuse cytoplasmic SSTR2A expression was identified in all TIO patients and focal weak nuclear staining in 12 of 15 controls. FGF23 cytoplasmic expression was identified in 11 of 18 TIO patients and diffuse nuclear staining in 9 of 9 controls. The H score was higher in
SSTR2A than in FGF23 IHC (median [interquartile range]: 6 [6-6] vs 1 [0-2], P < .001).
SSTR2A IHC with H-score quantification might be a more sensitive, adjunctive diagnostic tool than FGF23 IHC for TIO diagnosis.