Sekar A, Gupta N, Rajwanshi A, Chaturvedi R, Singh N, Lal A
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cytopathology. 2017 Oct;28(5):371-377. doi: 10.1111/cyt.12445. Epub 2017 Jul 21.
Approximately 10% of non-small-cell lung cancer (NSCLC) remains unclassifiable as NSCLC-not otherwise specified (NOS), after using a panel of immunomarkers. The present study was undertaken to assess sensitivity and specificity of immunomarkers in sub-typing NSCLC on fine needle aspiration cytology (FNAC). Epidermal growth factor receptor (EGFR) mutations were also detected in these samples.
Sixty cases of NSCLC including 15 squamous cell carcinoma (SCC), 15 adenocarcinomas (ADC) and 30 NSCLC-NOS reported on FNAC were included in the study. A panel of CK7, CK5/6, TTF-1 and p63 was applied in these cases. DNA was extracted from 54 cases including 14 effusion samples, and EGFR mutations were detected.
Classic ADC cases (n=15) showed 73.3% TTF-1 positivity and 100% CK7 positivity. Two cases of ADC showed aberrant expression of p63 and 2 cases showed CK5/6 positivity. 80% of classic SCC cases (n=15) showed strong nuclear p63 positivity and 86.6% were positive for CK5/6. TTF-1 was seen exclusively in ADC cases. Immunohistochemistry (IHC) using two immunomarkers (TTF-1 and p63) helped in subtyping 24/30(80%) cases of NSCLC. EGFR mutations were detected in 9/54 (16.7%) cases, and the most common mutation was short in-frame deletion in Exon 19.
More than 90% of NSCLC can be sub-typed on cytology samples with the help of immunochemistry. The sensitivity of TTF-1, p63, CK5/6 and CK7 was 73.3%, 80%, 100% and 100%, respectively. The specificity of TTF-1, p63, CK5/6 and CK7 was 100%, 86.6%, 86.6% and 93.3%, respectively. TTF-1 is highly specific, and almost 80% of NSCLC-NOS cases can be sub-typed using TTF-1 and p63. EGFR mutations can be detected in cytology samples, and 16.7% samples were positive for EGFR mutations.
在使用一组免疫标志物后，约10%的非小细胞肺癌（NSCLC）仍无法归类为非小细胞肺癌-未另行特指（NOS）。本研究旨在评估免疫标志物在细针穿刺细胞学检查（FNAC）中对NSCLC进行亚型分类的敏感性和特异性。还对这些样本检测了表皮生长因子受体（EGFR）突变。
本研究纳入了60例经FNAC报告的NSCLC病例，包括15例鳞状细胞癌（SCC）、15例腺癌（ADC）和30例NSCLC-NOS。对这些病例应用了一组CK7、CK5/6、TTF-1和p63。从54例病例中提取DNA，包括14例积液样本，并检测EGFR突变。
典型ADC病例（n=15）显示TTF-1阳性率为73.3%，CK7阳性率为100%。2例ADC病例显示p63异常表达，2例显示CK5/6阳性。80%的典型SCC病例（n=15）显示核p63强阳性，86.6%的病例CK5/6阳性。TTF-1仅见于ADC病例。使用两种免疫标志物（TTF-1和p63）的免疫组织化学（IHC）有助于对24/30（80%）例NSCLC进行亚型分类。在9/54（16.7%）例病例中检测到EGFR突变，最常见的突变是外显子19的框内短缺失。
借助免疫化学，超过90%的NSCLC可在细胞学样本上进行亚型分类。TTF-1、p63、CK5/6和CK7的敏感性分别为73.3%、80%、100%和100%。TTF-1、p63、CK5/6和CK7的特异性分别为100%、86.6%、86.6%和93.3%。TTF-1具有高度特异性，几乎80%的NSCLC-NOS病例可使用TTF-1和p63进行亚型分类。EGFR突变可在细胞学样本中检测到，16.7%的样本EGFR突变呈阳性。
