While it is true that a pathologist can diagnose without immunos (after all
diagnostic pathology existed pre-immunohistochemistry) it is uncommon for a
pathologist not to use immunos, even in a limited capacity. Cases of a
certain nature may not call for immunos, but aside from that most
pathologists choose to employ them.
The fact that your immunos go out to be done (technical) and return to be
interpreted (professional) tells me that despite having a pathologist that
does not require them, there is enough work (and diagnostic understanding by
the other path) that it may be feasible to do your own. Gauging volumes has
merit, but you really need to figure out what works best for you. What I
mean by that is calculating a true cost. How much do you pay in technical
fees to have the immunos sent out? Does this involve other departments and
is there a cost associated with diagnostic delay? As long as you do the
interpretation your path should be capturing the professional charges.
Compare the cost of technical send-outs to the cost of running in-house.
This is where your volumes would come in. Volumes and frequency of antibody
type. Most suppliers of immunohistochemical products will help you
calculate this. They have an interest in being as accurate as possible
because it does them no good to have you as a customer if there truly is no
need on your part. Obviously some ABs cost more than others and then there
are ancillary costs for reagents etc. Many companies today (Dako, Ventana
etc.) will get you up and running. You can generally get an equipment
lease package with a reagent rental agreement. Or you could opt for manual
kits, although I prefer automation as it really eliminates variables. I
also believe that automation helps with troubleshooting and simplifies QC
for your paths and regulating agencies. I'm sure there are many monitoring
this list server that would be happy to provide you with more details on
Now for my own non-pathologist opinion on the importance of immunos...as an
AP Coordinator and someone who has been working in histopathology for almost
20 years I believe immunohistochemistry to be extremely important.
Antigen/antibody complexes are just too good a bio tool to NOT use. The day
is surely coming when the last pathologist to not use immunos will retire.
Onto your question about protocols other than breast...we run S-100 and
Melan A with every sentinel node case for melanoma (protocol). We don't
have any other protocol that is automatically ordered at the grossing bench
(other than sentinel node breast cases), however our paths like certain
lymphoma panels (CD markers) which are ordered on a case by case basis.
Generally a lot of ABs will be run together, CK7 and 20, Kappa/Lambda, etc.
but here again you really need to look at your unique service, what your
pathologist wants and if/how you can provide it.
Good luck to you!
Thomas G. Jasper
Anatomic Pathology Coordinator
Duluth, MN 55805
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