Transcription Factor Immunohistochemistry Improves Diagnostic Accuracy and Reduces Immunonegative Misclassification in Nonfunctional Pituitary Neuroendocrine Tumors
In brief
Transcription factor stains prevent 24% of nonfunctioning pituitary tumors being labeled immunonegative
In this single-center study of 173 surgically removed tumors, 41 patients had a lineage-specific transcription factor stain despite no matching pituitary hormone staining; hormone-only testing would have labeled them immunonegative. Transcription factor staining identified a lineage in 170 tumors overall, but these retrospective findings need confirmation beyond one institution.
- Journal
- World neurosurgery (Q2)
- Published
- 5 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Thomas Hanks, Zachary A Abecassis, Jessica Eaton, Spencer Raub, Dominic Nistal, Eric Lassiter, et al.
- PMID
- 42833555
- DOI
- 10.1016/j.wneu.2026.125390
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 11 October 2026): TF IHC improves NF PitNET diagnosis
Abstract
OBJECTIVE: Anterior pituitary hormone immunohistochemistry (IHC) for surgically resected nonfunctional pituitary neuroendocrine tumors (NF PitNET) underreports true rates of tumor lineage and biases toward immunonegative tumors. Here we compare our use of traditional IHC methods for identification of anterior pituitary hormones versus identification of lineage specific transcription factors (TF) to correctly identify NF PitNET lineage and review the literature for studies evaluating its efficacy. METHODS: A single institution, retrospective study of NF PitNETs undergoing surgical resection between 2021 and 2024 at the University of [blinded for review] was performed. Patients were included for study if pathology specimens had IHC performed for anterior pituitary hormones and lineage specific TF. RESULTS: A total of 173 patients with NF PitNETs were included. When stained for the lineage specific TFs: SF-1, PIT-1, and T-PIT, immunoreactivity was observed in 117 (66%), 18 (10%), and 35 (20%) tumors, respectively. Three (2%) patients demonstrated no positive staining for any TF and were classified as immunonegative. Of the 117 SF-1 tumors, 32 (27%) showed no positive staining for LH/FSH. For the 18 PIT-1 tumors, two (11%) showed no positive staining for PRL/GH/TSH. For the 35 TPIT tumors, 7 (20%) showed no staining for ACTH. Overall, of the 170 patients who had positive staining for a single TF, 41 (24%) did not show IHC staining for their corresponding anterior pituitary hormones and thus would have been classified as immunonegative PitNETs. CONCLUSION: Use of IHC for identification of lineage specific TF markedly improves the accuracy of correct pathological diagnosis of NF PitNETs.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.