Fatima Nazneen, Cohen Cynthia, Lawson Diane, Siddiqui Momin T
Department of Pathology, Emory University Hospital, Atlanta, Georgia 30322, USA.
Diagn Cytopathol. 2012 Nov;40(11):943-8. doi: 10.1002/dc.21678. Epub 2011 Apr 6.
Increasing demand for accurate differentiation of pulmonary squamous cell carcinoma (SQCC) from other subtypes can be challenging for pathologists. This is more so in fine-needle aspirations (FNA) since the sample is small and SQCC may show degenerative changes and necrosis that distort the cellular features. Immunohistochemistry (IHC) is a valuable adjunct, and CK5/6 and P63 immunoreactivity is found to be basically restricted to SQCC. In our study, we evaluated the efficiency of CK5/P63 double staining in the diagnosis of pulmonary SQCC in cell blocks (CB) of lung FNA. We used a cohort including 24 CB of lung SQCC and 34 CB of lung adenocarcinomas (ADC). IHC was performed for CK5/P63 double stain. Seventeen of 24 (70%) lung SQCC were positive for the double stain CK5/P63. Two (8%) were positive for CK5 alone and two (8%) were positive for P63 alone. Thus, a total 19 of 24(79%) SQCC of the lung were positive for CK5 and P63 each. In ADC, no immunoreactivity was detected for CK5 alone or combined CK5/P63. Three of 34(8%) ADC were positive for P63. This first study of double staining of CK5/P63 in FNA CB shows a sensitivity of 70% and specificity of 100% for SQCC of the lung. When each marker staining alone is included, the sensitivity for CK5 and P63 increases to 79% each. This double stain can help in the diagnosis of pulmonary SQCC with an accuracy of 88% and a positive predictive value of 100%.
对病理学家而言，越来越高的准确区分肺鳞状细胞癌（SQCC）与其他亚型的需求颇具挑战性。在细针穿刺抽吸活检（FNA）中更是如此，因为样本较小，且SQCC可能会出现退行性变和坏死，从而扭曲细胞特征。免疫组织化学（IHC）是一项有价值的辅助手段，发现细胞角蛋白5/6（CK5/6）和P63免疫反应性基本局限于SQCC。在我们的研究中，我们评估了CK5/P63双重染色在肺FNA细胞块（CB）中诊断肺SQCC的效率。我们使用了一个队列，包括24例肺SQCC的CB和34例肺腺癌（ADC）的CB。对CK5/P63进行双重染色的IHC检测。24例肺SQCC中有17例（70%）CK5/P63双重染色呈阳性。2例（8%）仅CK5呈阳性，2例（8%）仅P63呈阳性。因此，24例肺SQCC中共有19例（79%）CK5和P63各自呈阳性。在ADC中，未检测到单独CK5或联合CK5/P63的免疫反应性。34例ADC中有3例（8%）P63呈阳性。这项关于FNA CB中CK5/P63双重染色的首次研究显示，对肺SQCC的敏感性为70%，特异性为100%。当单独包括每个标志物染色时，CK5和P63的敏感性各自增加到79%。这种双重染色有助于诊断肺SQCC，准确率为88%，阳性预测值为100%。
