Department of Histopathology, Royal Brompton Hospital, London.
J Thorac Oncol. 2010 Apr;5(4):436-41. doi: 10.1097/JTO.0b013e3181c6ed9b.
The dichotomization of non-small cell carcinoma (NSCLC) subtype into squamous (SQCC) and adenocarcinoma (ADC) has become important in recent years and is increasingly required with regard to management. The aim of this study was to determine the utility of a panel of commercially available antibodies in refining the diagnosis on small biopsies and also to determine whether cytologic material is suitable for somatic EGFR genotyping in a prospectively analyzed series of patients undergoing investigation for suspected lung cancer.
Thirty-two consecutive cases of NSCLC were first tested using a panel comprising cytokeratin 5/6, P63, thyroid transcription factor-1, 34betaE12, and a D-PAS stain for mucin, to determine their value in refining diagnosis of NSCLC. After this test phase, two further pathologists independently reviewed the cases using a refined panel that excluded 34betaE12 because of its low specificity for SQCC, and refinement of diagnosis and concordance were assessed. Ten cases of ADC, including eight derived from cytologic samples, were sent for EGFR mutation analysis.
There was refinement of diagnosis in 65% of cases of NSCLC to either SQCC or ADC in the test phase. This included 10 of 13 cases where cell pellets had been prepared from transbronchial needle aspirates. Validation by two further pathologists with varying expertise in lung pathology confirmed increased refinement and concordance of diagnosis. All samples were adequate for analysis, and they all showed a wild-type EGFR genotype.
A panel comprising cytokeratin 5/6, P63, thyroid transcription factor-1, and a D-PAS stain for mucin increases diagnostic accuracy and agreement between pathologists when faced with refining a diagnosis of NSCLC to SQCC or ADC. These small samples, even cell pellets derived from transbronchial needle aspirates, seem to be adequate for EGFR mutation analysis.
近年来，非小细胞肺癌（NSCLC）亚型的二分法（分为鳞癌[SQCC]和腺癌[ADC]）变得非常重要，并且在管理方面的要求也越来越高。本研究的目的是确定一组商业上可获得的抗体在细化小活检诊断方面的效用，以及确定细胞学标本是否适合进行体细胞 EGFR 基因分型，方法是对一系列经前瞻性分析的疑似肺癌患者进行调查。
首先使用包含细胞角蛋白 5/6、P63、甲状腺转录因子-1、34βE12 和 D-PAS 黏液染色的抗体组合对 32 例连续 NSCLC 病例进行测试，以确定其在细化 NSCLC 诊断方面的价值。在测试阶段之后，另外两名病理学家使用排除 34βE12 的改良面板独立复查病例，因为其对 SQCC 的特异性低，评估诊断的细化和一致性。10 例 ADC 包括 8 例来源于细胞学样本，被送往 EGFR 突变分析。
在测试阶段，65%的 NSCLC 病例被细化为 SQCC 或 ADC。这包括从经支气管针吸活检制备细胞沉淀的 13 例中的 10 例。具有不同肺部病理学专业知识的两名进一步病理学家的验证证实了诊断的细化和一致性增加。所有样本均适合分析，并且均显示野生型 EGFR 基因型。
包含细胞角蛋白 5/6、P63、甲状腺转录因子-1 和 D-PAS 黏液染色的抗体组合可提高病理学家在将 NSCLC 诊断细化为 SQCC 或 ADC 时的诊断准确性和一致性。这些小样本，甚至是从经支气管针吸活检制备的细胞沉淀，似乎也足以进行 EGFR 突变分析。
