ADH-5 (Breast Marker Cocktail)

Microinvasion; CK7/18 only (FR). Loss of CK5/14 and p63 (DAB)

CK5, CK14, p63, CK7 and CK18 have routinely been used as a panel of IHC markers to complement morphological evaluation in the assessment of difficult to diagnose breast lesions; due to the differential expression of the luminal vs. basal and myoepithelial markers(1,2). CK5 and CK14 are high molecular weight keratins expressed in the cytoplasm of basal cells and myoepithelium of breast tissue (1-2).

p63 is a transcription factor present in the nuclei of myoepithelial cells (1,2). In contrast, CK7 and CK18 are low molecular weight cytokeratins primarily expressed in luminal cells of the breast (1-2).

ADH-5™ Breast Marker Antibody Cocktail is comprised of mouse monoclonal anti-CK5, anti-CK14 and anti-p63 antibodies and rabbit monoclonal anti-CK7 and anti-CK18 antibodies.

Cases of Usual Ductal Hyperplasia (UDH) have been associated with expression of high molecular weight cytokeratins (CK5, CK14) and the nuclear marker p63 in the basal and myoepithelial cells, admixed with luminal cells expressing low molecular weight cytokeratins (CK7, CK18) (3-6).

Most cases of ADH and ductal carcinoma in situ (DCIS) were found to be negative for luminal CK5/14 staining and positive for luminal CK7/18 staining. Breast myoepithelial cells are usually stained with CK5/14 and/or p63(3-6).

IHC using a cocktail of CK5, CK14, p63, CK7 and CK18 antibodies, evaluated in combination with Hematoxylin and Eosin (H&E), has been shown to significantly increase diagnostic inter-observer agreement amongst pathologists, compared to H&E alone (7).

Staining of breast lesions should be carefully interpreted in conjunction with the morphological features of each individual case by a qualified pathologist.

1. Hicks DG, Immunohistochemistry in the Diagnostic Evaluation of Breast Lesions. Appl Immunohistochem Mol Morph 2011; 19:501-505.
2. Moriya T, et. al. New trends of immunohistochemistry for making differential diagnosis of breast lesions. Med Mol Morphol 2006; 39:8-13.
3. Otterbach F et. al., Cytokeratin 5/6 immunohistochemistry assists in differential diagnosis of atypical proliferations of the breast. Histopathology 2000; 37:232-40.
4. Boecker W, et. al. Usual ductal hyperplasia of the breast is a committed stem (progenitor) cell lesion distinct from atypical ductal hyperplasia and ductal carcinoma in situ. J Pathol 2002; 198:458-67.
5. Koo JS et. al. Comparison of Immunohistochemical Staining in Breast Papillary Neoplasm of Cytokeratin 5/6 and p63 in core Needle Biopsies and Surgical Excisions. Appl Immunohistochem Mol Morph 2012; 20:108-15.
6.Ichihara S, et. al. Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesions of the breast. Path Int 2007; 57:126-132.
7. Jain RK, et. al. Atypical ductal hyperplasia: interobserver and intraobserver variability. Mod Pathol 2011; 24:917-923.

Ordering Information Catalog Number Volume
Concentrate N/A N/A
Predilute PM 360DS AA, H
intelliPATH™ IP 360 DS G10
VP Echelon VP 360DSK G
A / AK = 0.1 ml B / BK = 0.5 ml C / CK = 1.0 ml G5 = 5.0 ml AA = 6.0 ml H / G25 = 25 ml L = 100 ml