在缺乏形态学分化的非小细胞肺癌活检标本的分类：包含 TTF-1、napsin A、p63 和 CK5/6 的免疫组织化学组合的应用。
Subclassification of non-small cell lung carcinomas lacking morphologic differentiation on biopsy specimens: Utility of an immunohistochemical panel containing TTF-1, napsin A, p63, and CK5/6.
机构信息
Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
出版信息
Am J Surg Pathol. 2011 Jan;35(1):15-25. doi: 10.1097/PAS.0b013e3182036d05.
The availability of targeted therapies has created a need for precise subtyping of non-small cell lung carcinomas (NSCLCs). The aim of this study was to assess the utility of immunohistochemical markers in subtyping poorly differentiated NSCLC and to compare the results of immunohistochemical staining on biopsies with the corresponding resections. Thirty-nine cases of NSCLC that could not be further classified on biopsy and had subsequent resection specimens were identified. Classification of the tumor was based on the resection specimen using the World Health Organization criteria. All biopsies and resections were stained with CK7, TTF-1, napsin A (novel aspartic proteinase of the pepsin family), p63, CK5/6, and 34βE12. The specimens included 20 adenocarcinomas (ACs), 15 squamous cell carcinomas (SCCs), and 4 large-cell carcinomas (LCCs). TTF-1 was positive in biopsies from 16 of 20 ACs, 2 of 4 LCCs, and none of the SCCs. p63 was positive in all 15 SCCs, 2 of 20 ACs (both were also positive for TTF-1 and napsin A), and none of the LCCs. CK5/6 was positive in 11 of 15 SCCs (all p63 positive) but none of the ACs or LCCs. Napsin A stained 11 of 19 ACs (all TTF-1 positive) but none of the other tumors. Staining for CK7 was present in 19 of 19 ACs and 9 of 15 SCCs. 34βE12 stained both SCCs (15 of 15) and ACs (12 of 20). The combination of TTF-1, napsin A, p63, and CK5/6 allowed an accurate classification of 30 of39 (77%) cases. Of 232 pairs of slides (biopsy and resection) stained with immunohistochemical markers, 12 (5%) showed discrepancies in immunohistochemical staining between biopsies and their corresponding resections. Immunohistochemical staining using a combination of TTF-1, napsin A, p63, and CK5/6 allows subclassification of poorly differentiated NSCLCs on small lung biopsies in most cases. Discrepancies in immunohistochemical staining between biopsies and resections are uncommon.
免疫组织化学标志物在非小细胞肺癌（NSCLC）的亚分型中的应用价值。本研究旨在评估免疫组织化学标记物在低分化 NSCLC 分型中的作用，并比较活检和相应切除标本的免疫组织化学染色结果。确定了 39 例活检无法进一步分类且随后有切除标本的 NSCLC 病例。肿瘤分类基于使用世界卫生组织标准的切除标本。所有活检和切除标本均用 CK7、TTF-1、napsin A（胃蛋白酶家族的新型天冬氨酸蛋白酶）、p63、CK5/6 和 34βE12 染色。标本包括 20 例腺癌（ACs）、15 例鳞状细胞癌（SCCs）和 4 例大细胞癌（LCCs）。TTF-1 在 20 例 AC 中的 16 例、4 例 LCC 中的 2 例和 15 例 SCC 中的均为阳性。p63 在所有 15 例 SCC 中均为阳性，在 20 例 AC 中的 2 例（均为 TTF-1 和 napsin A 阳性）和 4 例 LCC 中均为阴性。CK5/6 在 15 例 SCC 中的 11 例（均为 p63 阳性）和 19 例 AC 中均为阴性。napsin A 在 19 例 AC 中的 11 例（均为 TTF-1 阳性）和 15 例 SCC 中的均为阳性。CK7 在 19 例 AC 中的 19 例和 15 例 SCC 中的 9 例均为阳性。34βE12 在 15 例 SCC 中均为阳性（均为阳性）和 20 例 AC 中的 12 例。TTF-1、napsin A、p63 和 CK5/6 的组合可准确分类 39 例中的 30 例（77%）。在 232 对（活检和切除）用免疫组织化学标志物染色的载玻片上，12 对（5%）在活检和相应切除标本之间的免疫组织化学染色存在差异。在大多数情况下，在小肺活检中使用 TTF-1、napsin A、p63 和 CK5/6 的组合可对低分化 NSCLC 进行亚分类。活检和切除标本之间的免疫组织化学染色差异并不常见。
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