Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pulmonary Medicine & Sleep Disorder, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2017 Jul;146(1):42-48. doi: 10.4103/ijmr.IJMR_1221_15.
BACKGROUND & OBJECTIVES: Accurate histopathological subtyping of non-small cell lung carcinoma (NSCLC) is essential for targeted therapeutic agents. Immunohistochemistry (IHC) is helpful in identification of different tumour subtypes. In this study two marker approaches, one each for glandular and squamous cell differentiation was applied to maximize the proportion of accurately subtyped NSCLC not otherwise specified (NOS) tumours on small biopsy samples.
Two hundred and sixty three consecutive lung biopsies of primary lung carcinoma were prospectively studied. These were subtyped first morphologically and then by IHC for p40 and thyroid transcription factor-1 (TTF-1). The diagnosis of NSCLC-NOS before and after addition of IHC was evaluated. Results were correlated and validated with morphologically proven cases and matched surgical specimens.
Based on morphology, only 140 of the 263 (53.2%) cases of NSCLC were characterized, whereas 123 (46.7%) were classified as NSCLC-NOS type. With addition of IHC (p40 and TTF-1), the latter category reduced to 14.4 per cent and a sum of 225 (85.5%) cases were accurately subtyped into squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma. p40 showed 100 per cent sensitivity and specificity for squamous differentiation whereas TTF-1 showed sensitivity of 85.3 per cent and specificity of 98.1 per cent. Ninety per cent correlation of morphologic subtypes was achieved with matched resected specimens.
INTERPRETATION & CONCLUSIONS: Our results showed that an approach of using only a two-antibody panel (p40 and TTF-1) might help in reduction of diagnostic category of NSCLC-NOS significantly and contribute in saving tissue for future molecular testing.
准确的非小细胞肺癌（NSCLC）组织病理学亚型分类对靶向治疗药物至关重要。免疫组织化学（IHC）有助于识别不同的肿瘤亚型。本研究应用两种标记物方法，分别用于腺分化和鳞状细胞分化，以最大限度地提高非小细胞肺癌（NOS）肿瘤在小活检样本中的准确分类比例。
前瞻性研究了 263 例连续的原发性肺癌肺活检。首先进行形态学分类，然后通过 p40 和甲状腺转录因子-1（TTF-1）的 IHC 进行分类。评估添加 IHC 前后非小细胞肺癌（NOS）的诊断。结果与形态学证实的病例和匹配的手术标本进行了相关性和验证。
基于形态学，263 例 NSCLC 中只有 140 例（53.2%）得到了特征描述，而 123 例（46.7%）被归类为 NSCLC-NOS 型。通过添加 IHC（p40 和 TTF-1），后者的比例降至 14.4%，225 例（85.5%）的病例被准确地分为鳞状细胞癌、腺癌和腺鳞癌。p40 对鳞状分化的敏感性和特异性均为 100%，而 TTF-1 的敏感性为 85.3%，特异性为 98.1%。与匹配的切除标本相比，形态学亚型的相关性达到 90%。
我们的结果表明，使用仅两种抗体（p40 和 TTF-1）的方法可能有助于显著减少非小细胞肺癌（NOS）的诊断类别，并有助于为未来的分子检测节省组织。
