Usefulness of immunohistochemical and histochemical studies in the classification of lung adenocarcinoma and squamous cell carcinoma in cytologic specimens.

Histologic subtyping of non-small cell lung carcinoma (NSCLC) is important because the efficacy of new treatments depends on tumor histologic features. We assessed the diagnostic accuracy of classification of lung adenocarcinoma and squamous cell carcinoma (SCC) on cytologic and biopsy specimens based on cytomorphologic studies alone or in combination with ancillary studies compared with resection specimens. Compared with adenocarcinoma, the diagnosis of SCC was based more often on cytomorphologic studies alone (139/185 [75.1%] vs 107/263 [40.7%]). Significantly increased use of immunohistochemical studies in cytology was noted after introduction of targeted lung carcinoma therapies (22/156 [14.1%] for adenocarcinoma and 5/46 [11%] for SCC from 2000-2004 vs 134/156 [85.9%] for adenocarcinoma and 41/46 [89%] for SCC from 2005-2010). Use of immunohistochemical studies resulted in increased diagnostic accuracy for adenocarcinoma (56% [44/78] from 2000-2004 vs 83.2% [154/185] after 2005) but not for SCC (77% [57/74] before 2004 vs 73.9% [82/111] from 2005-2010). Adenocarcinoma showed high expression of cytokeratin (CK)7 (146/146 [100%]), thyroid transcription factor-1 (131/152 [86.2%]), surfactant A (29/36 [81%]), and periodic acid-Schiff with diastase (69/86 [80%]). All SCCs were positive for CK5/6 and p63. Use of immunohistochemical studies on cytologic cell blocks may improve classification of NSCLC.