J Lung Cancer.  2012 Jun;11(1):21-32. 10.6058/jlc.2012.11.1.21.

A Minimal Immunohistochemical Panel for Subtyping Poorly Differentiated Non-Small Cell Lung Carcinoma: A Tissue Microarray Study Simulating Small Biopsy Conditions

• Kim GY
• Lim SJ
• Kim WS
• Lee GK

• KMID: 2199873
• DOI: http://doi.org/10.6058/jlc.2012.11.1.21

Abstract

PURPOSE
Given the emerging evidence for differential responses to new targeted therapies and the identification of molecular differences between specific subtypes of non-small cell lung carcinoma (NSCLC), there is an increased need for greater accuracy in subtyping NSCLC. In a substantial proportion of cases, standard morphology cannot specifically subtype the tumor, resulting in a final diagnosis of NSCLC-not otherwise specified. In this study, we added newly proposed markers (napsin A, desmocollin-3) to conventional markers (p63, thyroid transcription factor-1 [TTF-1], cytokeratin 5/6 [CK5/6], high molecular weight cytokeratin [HMWCK], cytokeratin 7 [CK7]) and evaluated for the minimal panel of immunohistochemical markers required for subtyping poorly differentiated (PD) NSCLC.
MATERIALS AND METHODS
Resection specimens of 110 adenocarcinomas (ADCs) and 171 squamous cell carcinomas (SCCs) were collected and tissue microarrays were constructed to simulate small biopsy conditions. All specimens were stained with TTF-1, napsin A, CK7, p63, CK5/6, HMWCK, desmocollin-3 and mucicarmine.
RESULTS
For 32 PD ADC, a combination of TTF-1 and napsin A increased sensitivity (81%). With regard to the 29 PD SCC, a combination of desmocollin-3 and p63 did not substantially increase diagnostic performance. Logistic regression analysis identified napsin A, p63 and TTF-1 as the optimal panel to separate PD ADC and PD SCC. Mucin stains for PD NSCLC increased accuracy rate (88%) for diagnosis of PD ADC.
CONCLUSION
We recommend a minimal panel of immunohistochemical and histochemical markers to include TTF-1, p63, napsin A and one of mucin stains for tumor subtyping of PD NSCLC in a small biopsy sample.

Keyword

Lung neoplasms; Adenocarcinoma; Squamous cell carcinoma; Immunohistochemistry; Histochemistry

MeSH Terms

Adenocarcinoma
Biopsy
Carcinoma, Squamous Cell
Coloring Agents
Immunohistochemistry
Keratin-7
Keratins
Logistic Models
Lung
Lung Neoplasms
Molecular Weight
Mucins
Thyroid Gland
Coloring Agents
Keratin-7
Keratins
Mucins

Figure

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  Fig. 1 Immunohistochemical staining. (A) Thyroid transcription factor-1-positive adenocarcinoma showing nuclear staining, (B) napsin A-positive adenocarcinoma showing cytoplasmic staining, (C) cytokerain 7-positive adenocarcinoma showing cytoplasmic staining, (D) p63-positive squamous cell carcinoma showing nuclear staining, (E) desmocollin-3-positive squamous cell carcinoma showing cytoplasmic staining, and (F) cytokeratin 5/6-positive squamous cell carcinoma showing cytoplasmic staining (A~F, polymer method, ×200).

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