Stojsic J, Jovanic I, Markovic J, Gajic M
Department of Thoracopulmonary Pathology, Clinical Centre of Serbia, Belgrade, Serbia.
J BUON. 2013 Jan-Mar;18(1):176-87.
Targeted therapy increases survival and the quality of life of non-small cell lung cancer (NSCLC) patients but it needs precise histological subtyping. The present study evaluated 6 monoclonal antibodies for the differential diagnosis of NSCLC on small-sized tissue samples.
50 small-sized tissue samples were obtained by bronchoscopy or fine needle aspiration biopsy (FNAB). According to morphology before immunohistochemistry 2 squamous cell carcinomas (SCC), 6 adenocarcinomas (AC), 9 NSCLC-probably SCC, 11 NSCLC-probably AC and 22 unclassified NSCLCs were diagnosed. Thyroid transcription factor-1 (TTF-1), cytokeratin 5/6, cytokeratin 7, p63, and the neuroendocrine markers CD56 and synaptophysin were used in the differential diagnosis of NSCLC.
After immunohistochemistry 13 (26.0%) SCC, 27 (54.0%) AC, 3 (6.0%) NSCLC with neuroendocrine differentiation (NSCLC-NE) and 7 (14.0%) NSCLC- unclassified were diagnosed. Twenty-two NSCLC- unclassified were further diagnosed as SCC (n=7), AC (n=7) NSCLC-NE (n=2) and 6 remained NSCLC- unclassified. Significant difference was found between definitely diagnosed 8 NSCLCs and 15 ACs (20.5 vs. 38.57percnt;, p=0.008). TTF-1 and cytokeratin 7 were expressed in 85.2% (23/27) of AC, and cytokeratin 5/6 and p63 in 100% (13/13) of SCC. Positivity of CD56 and synaptophysin in 3 NSCLC determined NSCLC-NE.
No one monoclonal antibody is totally specified for one histological type of tumor and its origin. Combination of TTF-1, cytokeratin 7, p63, cytokeratin 5/6, CD56 and synaptophysin allows for differentiation of NSCLC but Napsin-A for AC differentiation and chromogranin A for NSCLC-NE differentiation should be added in an optimal panel.
靶向治疗可提高非小细胞肺癌（NSCLC）患者的生存率和生活质量，但需要精确的组织学亚型分类。本研究评估了6种单克隆抗体用于在小尺寸组织样本上对NSCLC进行鉴别诊断。
通过支气管镜检查或细针穿刺活检（FNAB）获取50个小尺寸组织样本。根据免疫组化前的形态学诊断出2例鳞状细胞癌（SCC）、6例腺癌（AC）、9例可能为SCC的NSCLC、11例可能为AC的NSCLC和22例未分类的NSCLC。甲状腺转录因子-1（TTF-1）、细胞角蛋白5/6、细胞角蛋白7、p63以及神经内分泌标志物CD56和突触素用于NSCLC的鉴别诊断。
免疫组化后诊断出13例（26.0%）SCC、27例（54.0%）AC、3例（6.0%）具有神经内分泌分化的NSCLC（NSCLC-NE）和7例（14.0%）未分类的NSCLC。22例未分类的NSCLC进一步诊断为SCC（n = 7）、AC（n = 7）、NSCLC-NE（n = 2），6例仍为未分类的NSCLC。在明确诊断的8例NSCLC和15例AC之间发现显著差异（20.5%对38.57%，p = 0.008）。TTF-1和细胞角蛋白7在85.2%（23/27）的AC中表达，细胞角蛋白5/6和p63在100%（13/13）的SCC中表达。3例NSCLC中CD56和突触素的阳性确定为NSCLC-NE。
没有一种单克隆抗体能完全特异性地针对一种肿瘤组织学类型及其起源。TTF-1、细胞角蛋白7、p63、细胞角蛋白5/6、CD56和突触素的联合使用可实现NSCLC的鉴别，但在最佳组合中应添加Napsin-A用于AC鉴别和嗜铬粒蛋白A用于NSCLC-NE鉴别。
