The Significant Impact of Immunohistochemistry in the Classification of Lung Carcinoma on Small Biopsies

2021 ◽  
Vol 8 (3) ◽  
pp. 60-65
Author(s):  
Debjani Mallick ◽  
Sayan Kundu ◽  
Sudipta Chakrabarti ◽  
Prosun Gayen
Keyword(s):  
Cell Carcinoma ◽  
Squamous Cell ◽  
Lung Carcinoma ◽  
Clinical Findings ◽  
Small Cell ◽  
Napsin A ◽  
Morphological Diagnosis ◽  
Poorly Differentiated ◽  
Undifferentiated Tumors

Background : There are limitations of histomorphology in the appropriate categorization of lung carcinoma where immunohistochemistry can confirm the morphological diagnosis and may add value in the poorly differentiated and undifferentiated tumors. The aim of the study was to assess the role of immunohistochemistry in classifying lung carcinoma on small biopsy samples. Methods and Material: A retrospective hospital based, observational study was conducted on cases of lung carcinoma diagnosed by core needle or bronchoscopic biopsies over a 3- year period. After evaluation of clinical findings and H&E sections, all biopsies were evaluated by immunohistochemical staining. The immunohistochemistry panel included cytokeratin cocktail, CK7, CK 20, TTF1, Napsin A, CK5/6, p40, synaptophysin, chromogranin, CD 56. Result: Out of 78 cases, the mean age was 58 +/- 11 years. Most prevalent malignancy type was adenocarcinoma (30, 38.1%). Adenocarcinoma cases were positive for CK7 (25/26, 96%), Napsin A (24/26, 92%), TTF1 (15/30, 50%) and negative for CK 20. Squamous cell carcinoma cases showed positivity for p40(18/22, 82%) and CK 5/6 (17/22.71%).Small cell carcinoma showed positivity for neuroendocrine markers synaptophysin (5/7,71%) and chromogranin(4/7, 57%) and CD 56 (6/7cases (85%).88% of small cell carcinomas,75% of adenocarcinomas and 72 % of squamous cell carcinomas were accurately diagnosed by morphology. Morphologic prediction was poor in the NSCC NOS group (0%) and poorly differentiated carcinomas (64%), which were finally, diagnosed by immunohistochemistry.In the morphologically diagnosed cases, immunohistochemistry confirmed the diagnosis. Conclusion: Thus, morphology added with immunohisto chemistry provides a crisp diagnosis thereby improving therapeutic efficacy

Expressions of Thyroid Transcription Factor-1, Napsin A, p40, p63, CK5/6 and Desmocollin-3 in Non-Small Cell Lung Cancer, as Revealed by Imprint Cytology Using a Malinol-Based Cell-Transfer Technique

2015 ◽  
Vol 59 (6) ◽  
pp. 457-464 ◽  
Author(s):  
Toshiaki Kawai ◽  
Susumu Tominaga ◽  
Sadayuki Hiroi ◽  
Koji Kameda ◽  
Sho Ogata ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Small Cell ◽  
Imprint Cytology ◽  
Small Cell Lung ◽  
Thyroid Transcription Factor 1 ◽  
Thyroid Transcription Factor ◽  
Napsin A ◽  
Transcription Factor 1

Background: The introduction of new therapies has made it important to differentiate between adenocarcinoma and squamous cell carcinoma. To allow the use of various immunocytochemical stains on limited materials, we tried transferring cells from a given smear to multiple slides. Using touch-preparation samples of 215 surgically resected non-small cell lung carcinomas of confirmed histologic classification (adenocarcinoma,n = 101; squamous cell carcinoma,n = 114), we performed immunocytochemistry for thyroid transcription factor-1, napsin A, p40, p63, CK5/6 and desmocollin-3, and compared cytologic staining results with the corresponding resection. Methods: We examined: (a) the expressions of the above 6 antibodies on cells transferred from touch imprints of resected specimens, the extent of staining being considered positive if more than 5% of the area was stained, and (b) the sensitivity, specificity, positive predictive value and negative predictive value for each antibody. Results: The histologic corresponding rate with Papanicolaou staining was only 73%. Regarding the differentiation of adenocarcinoma from squamous cell carcinoma, the sensitivity and specificity for napsin A in adenocarcinoma were 80 and 97%, respectively, while those for p40 in squamous cell carcinoma were 84 and 98%, respectively. Conclusion: The immunocytochemical expressions of napsin A and p40 in imprint cytology seem to be of great utility for the accurate histological differentiation of lung cancers.

Napsin A, a New Marker for Lung Adenocarcinoma, Is Complementary and More Sensitive and Specific Than Thyroid Transcription Factor 1 in the Differential Diagnosis of Primary Pulmonary Carcinoma: Evaluation of 1674 Cases by Tissue Microarray

2012 ◽  
Vol 136 (2) ◽  
pp. 163-171 ◽  
Author(s):  
Bradley M. Turner ◽  
Philip T. Cagle ◽  
Irma M. Sainz ◽  
Junya Fukuoka ◽  
Steven S. Shen ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Squamous Cell ◽  
Lung Squamous Cell Carcinoma ◽  
Negative Control ◽  
Small Cell ◽  
Tumor Type ◽  
Napsin A ◽  
N 93

Context.—Differentiation of non–small cell carcinoma into histologic types is important because of new, successful therapies that target lung adenocarcinoma (ACA). TTF-1 is a favored marker for lung ACA but has limited sensitivity and specificity. Napsin A (Nap-A) is a functional aspartic proteinase that may be an alternative marker for primary lung ACA. Objectives.—To compare Nap-A versus TTF-1 in the typing of primary lung carcinoma and the differentiation of primary lung ACA from carcinomas of other sites. Design.—Immunohistochemistry for Nap-A and TTF-1 was performed on tissue microarrays of 1674 cases of carcinoma: 303 primary lung ACAs (18.1%), 200 primary squamous cell lung carcinomas (11.9%), 52 primary small cell carcinomas of the lung (3.1%), and carcinomas of the kidney (n  =  320; 19.1%), thyroid (n  =  96; 5.7%), biliary (n  =  89; 5.3%), bladder (n  =  47; 2.8%), breast (n  =  93; 5.6%), colon (n  =  95; 5.7%), liver (n  =  96; 5.7%), ovaries (n  =  45; 2.7%), pancreas (n  =  48; 2.9%), prostate (n  =  49; 2.9%), stomach (n  =  93; 5.6%), and uterus (n  =  48; 2.9%). Cases were evaluated against a negative control as negative, weak positive, and strong positive. Results.—Nap-A was more sensitive than TTF-1 for primary lung ACA (87% versus 64%; P < .001). Nap-A was more specific than TTF-1 for primary lung ACA versus all tumors, excluding kidney, independent of tumor type (P < .001). Conclusions.—Nap-A is superior to TTF-1 in distinguishing primary lung ACA from other carcinomas (except kidney), particularly primary lung small cell carcinoma, and primary thyroid carcinoma. A combination of Nap-A and TTF-1 is useful in the distinction of primary lung ACA (Nap-A+, TTF-1+) from primary lung squamous cell carcinoma (Nap-A−, TTF-1−) and primary lung small cell carcinoma (Nap-A−, TTF-1+).

scholarly journals Distinction of pulmonary small cell carcinoma from poorly differentiated squamous cell carcinoma: an immunohistochemical approach

2004 ◽  
Vol 18 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Hong Zhang ◽  
Jing Liu ◽  
Philip T Cagle ◽  
Timothy C Allen ◽  
Alvaro C Laga ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Squamous Cell ◽  
Small Cell ◽  
Poorly Differentiated

scholarly journals Evaluation of P40 and Napsin A in the Differential Diagnosis of Non Small Cell Bronchogenic Carcinoma on Small Lung Biopsies

2022 ◽  
Vol 9 (01) ◽  
pp. 5800-5907
Author(s):  
Dr. Savita Singh ◽  
Dr. Kuldeep Singh
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Lung Carcinoma ◽  
Predictive Value ◽  
Small Cell Lung Carcinoma ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Immunohistochemical Markers ◽  
Napsin A

BACKGROUND :- Lung cancer is the leading cause of cancer-related mortality over word wide, Although the pathological diagnosis of lung carcinoma is limited as only small specimen available for diagnosis.the availability of targeted therapies has created a need for precise subtyping of non-small cell lung carcinoma . Several recent studies have demonstrated that the use of  Immunohistochemical markers can be helpful in differentiating lung squamous cell carcinoma (LSCC) from lung adenocarcinoma (LAC) not on surgically resected material but also on small biopsy samples and cytology. AIM  (1)          To classify the non small cell lung carcinoma  into major categories like squamous cell carcinoma (LSCC) and adenocarcinoma (LAC) and other categories by applying  immunohistochemicalmarker like  p40 (truncated p63) and Napsin A    (2)     To analyse the sensitivity and specificity of p40 and Napsin A in light of histomorphology and/or other relevant immunohistochemical markers available, using appropriate statistical tests. Material and methods:- This  study was a one and half year (18 months) prospective study from Jan 2017 to June 2018, conducted in department of pathology on patients attending the outpatient and inpatient department of TB and respiratory disease, a total of  210 bronchoscopic guided biopsies / transthoracic (CT/MRI /guided) small tissue biopsies from the patients suspected of lung malignancy were incorporated in the study. 20 corresponding resection specimens (wedge resection and lobectomy) were also included in the study for correlation of morphology and immunohistochemical findings on small biopsies. RESULTS:-In our study IHC for both p40 and napsin –A aided in subtyping of  71.9% cases of non small cell lung carcinoma and this diagnostic accuracy was found to be statistically significant with p-value < 0.05.,on statistical analysis  we found that napsin-A had a sensitivity of  90% and specificity of 80%. Also, positive predictive value and negative predictive value were seen to be 88.0% and 81.8% respectively.    

α-Methylacyl CoA Racemase in Pulmonary Adenocarcinoma, Squamous Cell Carcinoma, and Neuroendocrine Tumors: Expression and Survival Analysis

2007 ◽  
Vol 131 (10) ◽  
pp. 1555-1560
Author(s):  
Konstantin Shilo ◽  
Tatiana Dracheva ◽  
Haresh Mani ◽  
Junya Fukuoka ◽  
Isabell A. Sesterhenn ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Large Cell ◽  
Small Cell ◽  
Stage I ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma

Abstract Context.—α-Methylacyl CoA racemase (AMACR) is an oxidative enzyme involved in isomeric transformation of fatty acids entering the beta-oxidation pathway. AMACR serves as a useful marker in establishing a diagnosis of prostatic malignancy; however, limited information is available in regard to its presence in pulmonary neoplasms. Objective.—To investigate AMACR expression within a spectrum of lung carcinomas and its correlation with patients' survival. Design.—Four hundred seventy-seven pulmonary carcinomas, including 150 squamous cell carcinomas, 150 adenocarcinomas, 46 typical carcinoids, 31 atypical carcinoids, 28 large cell neuroendocrine carcinomas, and 72 small cell carcinomas, were studied immunohistochemically using tissue microarray–based samples. Results.—Overall, pulmonary tumors were positive for AMACR in a significant percentage (47%) of cases. Among tumor types, 22% of squamous cell carcinoma, 56% of adenocarcinoma, 72% of typical carcinoid, 52% of atypical carcinoid, 70% of large cell neuroendocrine carcinoma, and 51% of small cell lung carcinoma were positive for AMACR. Furthermore, the Kaplan-Meier analysis revealed that the patients with AMACR-positive small cell carcinoma had better survival (19% vs 5% after 5 years, P = .04) than patients with AMACR-negative tumors. Such survival advantage was seen for patients with stage I–II (P = .01) but not stage III–IV small cell carcinomas (P = .58). Conclusions.—These results indicate that, similar to prostate cancer, the overexpression of AMACR frequently occurs in pulmonary carcinomas. Additionally, its positive correlation with outcome of stage I–II small cell lung carcinoma warrants further investigation of the AMACR role in the prognosis of this tumor.

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