Immunohistochemistry in the Differential Diagnosis of Breast Spindle Cell and Sarcomatoid Lesions
A Narrative Review
DOI:
https://doi.org/10.61704/pr.642Keywords:
Immunohistochemistry, Breast Pathology, Spindle Cell Lesions, Sarcomatoid Neoplasms, Differential DiagnosisAbstract
Breast pathology encompasses a wide spectrum of lesions that are often difficult to diagnose, particularly spindle cell and sarcomatoid lesions. Although hematoxylin and eosin (H&E) examination remains the cornerstone of diagnosis, immunohistochemistry (IHC) is an essential adjunct in diagnostically challenging cases. However, inappropriate selection or interpretation of immunohistochemical markers may also lead to diagnostic pitfalls. This narrative review summarizes the current role of immunohistochemistry in the differential diagnosis of breast spindle cell and sarcomatoid lesions. The review focuses on the practical application of immunohistochemical markers alongside histomorphological features and clinical findings to distinguish metaplastic spindle cell carcinoma from benign spindle cell lesions, phyllodes tumors, primary breast sarcomas, and metastatic tumors. However, there is no single immunohistochemical marker provides absolute sensitivity and specificity in breast spindle cell pathology. Diagnostic accuracy relies on selecting an appropriate panel of markers according to the differential diagnosis and interpreting the findings together with the histomorphological features. Myoepithelial markers remain important for assessing stromal invasion, whereas lineage-associated markers, including GATA3, SOX10, and the recently introduced TRPS1, improve the identification of breast epithelial differentiation, particularly in triple-negative and metaplastic carcinomas. TRPS1 has also shown advantages over conventional breast markers in selected diagnostic settings. Immunohistochemistry remains an indispensable tool in the evaluation of breast spindle cell and sarcomatoid lesions. Reliable diagnosis requires careful correlation of immunohistochemical findings with histomorphological features and relevant clinical information, while the choice of antibody panel should always be guided by the specific diagnostic question.
Methods: This review article attempts to integrate the current understanding and practical applications of immunohistochemistry in resolving difficult cases of breast pathology. Emphasis is placed on the integration of immunophenotypic features with histomorphology and clinical parameters. Important diagnostic dilemmas include differentiation of ductal from lobular carcinomas, benign versus malignant spindle cell lesions, tumor invasion, and differentiation of primary from metastatic carcinomas.
Results: Currently, there are no immunohistochemical markers, which can show 100% sensitivity and specificity in breast pathology. Accurate diagnosis can only be obtained through the judicious selection of immunohistochemical markers, which are specific to particular diagnostic problems. Myoepithelial cell markers play an essential role in assessing tumor invasion, while tumor lineage-specific markers are useful in classifying tumors and determining tumor origin. Recently, new markers like TRPS1, which are associated with trichorhinophalangeal syndrome type 1, have been found to show high sensitivity in breast carcinomas, including both luminal and basal subtypes, including triple-negative breast cancer. These new markers have been found to have advantages over conventional markers in certain cases.
Conclusions: IHC is an extremely useful tool in breast pathology, but judicious use of this technique is essential. Optimal diagnostic accuracy can only be obtained through judicious use of IHC, careful evaluation of histomorphological features, and integration of clinical parameters.
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