ArticleDiagnostic pathology2026
Diagnosing carcinoma origin in ultrasound-guided needle biopsies: a context-driven approach anchored in site-specific immunohistochemical markers.
Article in Diagnostic pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn small-biopsy carcinomas, tumor-origin assignment often relies on limited tissue, clinical-radiologic context, morphology, and immunohistochemistry. Although site-specific markers are widely used to support tumor-origin assignment, how often such assignment is supported by site-specific-marker-anchored IHC without CK7/CK20 dependence in context-rich, non-CUP/MUO small-biopsy cohorts has been less explicitly addressed. We therefore audited selected small-biopsy carcinomas with a single-site origin assigned at sign-out, to assess how often tumor-origin assignment was supported by site-specific-marker-anchored IHC without CK7/CK20 dependence.
methodsWe reviewed 154 consecutive small biopsies with IHC and analyzed the selected subset of carcinomas in which a single-site origin had been assigned at sign-out. We retrospectively audited the IHC markers used to support tumor-origin assignment, assessing IHC panel sufficiency, site-specific-marker-anchored support without CK7/CK20 dependence, and CK7/CK20 application, theoretical need, and incremental contribution.
resultsThe selected analytic cohort included 60 carcinomas: 13 primary tumors, 43 metastases, and 4 malignancies of unknown origin submissions. Tumor origin was assigned as breast in 25% (15/60), colorectal in 20% (12/60), lung in 18% (11/60), and liver/hepatocellular carcinoma in 17% (10/60); other origins accounted for 20% (12/60). Overall diagnostic IHC sufficiency was achieved in 95% (57/60). Site-specific markers were applied in all cases. A site-specific-marker-anchored IHC approach was sufficient for tumor-origin assignment in 93% (56/60) of cases. CK7/CK20 was performed in 48% (29/60) of cases, was retrospectively considered theoretically needed in 12% (7/60), and was contributive to final tumor-origin assignment in 2% (1/60).
conclusionsIn this selected, context-rich, non-CUP/MUO small-biopsy cohort, tumor-origin assignment was supported in most cases (56/60, 93%) by site-specific-marker-anchored IHC without CK7/CK20 dependence; CK7/CK20 was selectively needed but showed limited incremental contribution beyond morphology, clinical/imaging context, and site-specific markers. This approach may have practical relevance for tissue-conscious IHC marker selection in small-biopsy workflows, alongside established pre-analytic standards. Further studies are warranted to confirm these findings, assess generalizability in broader biopsy settings, and evaluate diagnostic accuracy against external reference standards.
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