Diagnostic utility of p63/p40 in the histologic differentiation of salivary gland tumors: A systematic review.

Salivary gland tumors are a heterogeneous group of neoplasms with complex clinicopathologic behavior. These tumors often show an extremely diverse morphology and significant histologic patterns, making diagnosis a difficult task. Owing to the considerable differences in prognosis, treatment, and follow-up, accurately distinguishing these histologic mimickers is imperative. The aim of the present systematic review was to establish the diagnostic utility of p63/p40 immunostaining in histologic differentiation of salivary gland tumors. An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Trip, Cochrane Library, and EMBASE databases. Articles in which both p63 and p40 immunohistochemical expressions were assessed were included for systematic review and their sensitivity and specificity were calculated. Risk of bias was analyzed for each study using the Quality Assessment of Diagnostic Accuracy Studies tool. Ten eligible articles were included in the quantitative synthesis, which revealed a concordant positivity of p63 and p40 by nearly all cases of adenoid cystic carcinoma, pleomorphic adenoma, and mucoepidermoid carcinoma and most polymorphous adenocarcinomas showed discordant immunohistochemical expression (p63+/p40-). The current evidence supports that integrated immunostaining of p63/p40 is a valuable adjunct for discerning enigmatic salivary gland tumors with true myoepithelial and/or squamous differentiation.

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