Vinu Balraam K V, Shelly Divya, Mishra Prabha S, Sampath K S, Bharadwaj Reena
Departments of Pathology, Armed Forces Medical College, Pune, Maharashtra, India.
Department of Pathology, Command Hospital (Southern Command), Pune, Maharashtra, India.
South Asian J Cancer. 2019 Jul-Sep;8(3):191-194. doi: 10.4103/sajc.sajc_163_18.
The new IASLC/ATS/ERS classification provides standardized terminology for lung cancer diagnosis in small biopsies and cytology specimens.
The aim was to study the feasibility of the guidelines using one marker for adenocarcinoma (ADC) and one for squamous cell carcinoma (SQCC) in non-small cell lung carcinomas (NSCLCs).
In this study, we reviewed all the formalin-fixed paraffin-embedded tissue blocks diagnosed as lung carcinoma between July 2016 and December 2017. Cases were labeled as SCLC, ADC, SQCC, NSCLC favor ADC, NSCLC favor SQCC, NSCLC-not otherwise specified (NOS), and NSCLC-NOS possible adeno-SQCC (ADSQCC) as per IASLC/ATS/ERS 2011 guidelines. A three-step approach incorporating morphology, immunohistochemistry (IHC), and molecular analysis was used.
One hundred and nine cases were included. Six of the 109 cases were SCLC and 1 case was of large-cell neuroendocrine type. Of the remaining 102, 51 were diagnosed based on their classical histomorphology into SQCC (8) and ADC (43). Remaining 51 cases required IHC/special stains for categorization. The panel comprised anti-CK7, anti-thyroid transcription factor-1 (TTF-1), and anti-p63. Twenty-nine were positive for anti-TTF-1 and thus labeled as NSCLC favor ADC. Fifteen were labeled as NSCLC favor SQCC as they were highlighted by anti-p63. Four cases showed reaction to both the antibodies in different sets of tumor cells and thus were classified as NSCLC-NOS, possible ADSQCC. Remaining 3 cases did not show reaction to any of the antibodies and hence were labeled NSCLC-NOS.
The need for every laboratory to use minimal tissue for ancillary tests to diagnose lung carcinoma on small biopsies is reemphasized. Tissue from small biopsies needs to be preserved not only for the diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, in this era of personalized medicine.
国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）的新分类为小活检和细胞学标本中的肺癌诊断提供了标准化术语。
本研究旨在探讨在非小细胞肺癌（NSCLC）中使用一种腺癌（ADC）标志物和一种鳞状细胞癌（SQCC）标志物来应用该指南的可行性。
在本研究中，我们回顾了2016年7月至2017年12月期间所有诊断为肺癌的福尔马林固定石蜡包埋组织块。根据IASLC/ATS/ERS 2011指南，病例被标记为小细胞肺癌（SCLC）、ADC、SQCC、倾向于ADC的NSCLC、倾向于SQCC的NSCLC、未另行指定的NSCLC（NOS）以及可能为腺鳞癌（ADSQCC）的NSCLC-NOS。采用了一种结合形态学、免疫组织化学（IHC）和分子分析的三步法。
共纳入109例病例。109例中有6例为SCLC，1例为大细胞神经内分泌型。其余102例中，51例根据其典型组织形态学诊断为SQCC（8例）和ADC（43例）。其余51例需要通过IHC/特殊染色进行分类。该检测组合包括抗细胞角蛋白7（CK7）、抗甲状腺转录因子-1（TTF-1）和抗p63。29例抗TTF-1呈阳性，因此被标记为倾向于ADC的NSCLC。15例因抗p63染色阳性而被标记为倾向于SQCC的NSCLC。4例在不同肿瘤细胞组中对两种抗体均有反应，因此被分类为NSCLC-NOS、可能的ADSQCC。其余3例对任何抗体均无反应，因此被标记为NSCLC-NOS。
再次强调每个实验室在小活检中诊断肺癌时需要使用最少的组织进行辅助检测。在这个个性化医疗的时代，小活检组织不仅要用于诊断，还需要保存用于分子检测和治疗耐药标志物的评估。
