In interpreting p53 immunohistochemistry, an aberrant (mutation-type) pattern is not only strong diffuse nuclear staining. Complete absence of staining in the lesion with a positive internal control, and cytoplasmic staining, are also aberrant. Wild-type staining is patchy and variable in intensity. Misreading a null pattern as negative is a recognised cause of missed high-grade serous precursors and carcinomas.
- Check the internal control before calling a lesion p53-negative.
- Complete absence with a positive control is a null, aberrant pattern.
- Strong diffuse nuclear staining in most cells is aberrant overexpression.
- Scattered variable staining is the wild-type pattern.
- Report the pattern, not just positive or negative.
Why it matters
A null p53 read as negative can hide the very lesion the stain was ordered to find.
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