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A comparative study of quantitative immunohistochemistry and quantum dot immunohistochemistry for mutation carrier identification in Lynch syndrome
  1. Emma Barrow1,
  2. D Gareth Evans2,
  3. Ray McMahon3,4,
  4. James Hill1,
  5. Richard Byers3,4
  1. 1Department of General Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK
  2. 2Medical Genetics Research Group and Regional Genetics Service, University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
  3. 3Department of Pathology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
  4. 4School of Medicine, Stopford Building, Faculty of Medical and Human Sciences, University of Manchester, Oxford Road, Manchester, UK
  1. Correspondence to Miss Emma Barrow, Department of General Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; emma.barrow{at}


Aims Lynch Syndrome is caused by mutations in DNA mismatch repair (MMR) genes. Mutation carrier identification is facilitated by immunohistochemical detection of the MMR proteins MHL1 and MSH2 in tumour tissue and is desirable as colonoscopic screening reduces mortality. However, protein detection by conventional immunohistochemistry (IHC) is subjective, and quantitative techniques are required. Quantum dots (QDs) are novel fluorescent labels that enable quantitative multiplex staining. This study compared their use with quantitative 3,3′-diaminobenzidine (DAB) IHC for the diagnosis of Lynch Syndrome.

Methods Tumour sections from 36 mutation carriers and six controls were obtained. These were stained with DAB on an automated platform using antibodies against MLH1 and MSH2. Multiplex QD immunofluorescent staining of the sections was performed using antibodies against MLH1, MSH2 and smooth muscle actin (SMA). Multispectral analysis of the slides was performed. The staining intensity of DAB and QDs was measured in multiple colonic crypts, and the mean intensity scores calculated. Receiver operating characteristic (ROC) curves of staining performance for the identification of mutation carriers were evaluated.

Results For quantitative DAB IHC, the area under the MLH1 ROC curve was 0.872 (95% CI 0.763 to 0.981), and the area under the MSH2 ROC curve was 0.832 (95% CI 0.704 to 0.960). For quantitative QD IHC, the area under the MLH1 ROC curve was 0.812 (95% CI 0.681 to 0.943), and the area under the MSH2 ROC curve was 0.598 (95% CI 0.418 to 0.777).

Conclusions Despite the advantage of QD staining to enable several markers to be measured simultaneously, it is of lower utility than DAB IHC for the identification of MMR mutation carriers. Automated DAB IHC staining and quantitative slide analysis may enable high-throughput IHC.

  • Lynch syndrome
  • Hereditary nonpolyposis colorectal cancer
  • immunohistochemistry
  • DNA mismatch repair
  • Biological markers
  • Evaluation studies
  • quantum dot
  • cancer genetics
  • colorectal cancer
  • immunohistochemistry
  • quantitation

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  • Funding Work supported in part by grants from the Bowel Disease Research Foundation and Central Manchester and Manchester Children's University Hospitals NHS Trust Research Grant Scheme. This study group is supported by the NIHR Manchester Biomedical Research Centre.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Salford and Trafford Research Ethics Committee, project reference 07/Q1404/64.

  • Provenance and peer review Not commissioned; externally peer reviewed.