Utility of five commonly used immunohistochemical markers TTF-1, Napsin A, CK7, CK5/6 and P63 in primary and metastatic adenocarcinoma and squamous cell carcinoma of the lung: a retrospective study of 246 fine needle aspiration cases.
Utility of five commonly used immunohistochemical markers TTF-1, Napsin A, CK7, CK5/6 and P63 in primary and metastatic adenocarcinoma and squamous cell carcinoma of the lung: a retrospective study of 246 fine needle aspiration cases.
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DOI：
10.1186/s40169-015-0057-2
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发表时间：
2015
影响因子：
10.6
通讯作者：
Li QK
中科院分区：
文献类型：
--
作者：
Gurda GT;Zhang L;Wang Y;Chen L;Geddes S;Cho WC;Askin F;Gabrielson E;Li QK
细针穿刺活检在肺原发性和转移性肺癌的诊断和分期中起着至关重要的作用。腺癌（ADC）和/或鳞状细胞癌（SqCC）的准确亚分类对于靶向治疗至关重要。然而，在小的FNA标本中，区分ADC和SqCC可能很困难。在这里，我们回顾性地评估了TTF-1、Napsin A、CK7、P63和CK5/6免疫组化（IHC）标志物在ADC和SqCC的区分和亚分类中的应用。在两年的时间里，通过计算机搜索共发现246例FNA病例，其中包括102例原发性NSCLC和144例转移到其他部位的原发性NSCLC。TTF-1、Napsin A、CK7、P63、CK5/6的免疫染色模式与肿瘤的组织学诊断相关。在72例原发性adc中，TTF-1、Napsin A和CK7的敏感性和特异性分别为84.5%/96.4%、92.0%/100%和93.8%/50.0%。在30例原发性sqcc中，CK5/6和P63的敏感性和特异性分别为100%/77.8%和91.7%/78.3%。在131例转移性adc中，Napsin A的特异性最高（100%），而TTF-1（87.5%）和CK7（25%）的特异性最高，但敏感性较低（67.8%对86.9%和100%）；而在13例转移性sqcc中，CK5/6和P63的敏感性/特异性分别为100%/84.6%和100%/68.4%。Bootstrap分析显示，TTF-1/CK7、TTF-1/Napsin A和TTF-1/CK7/Napsin A联合检测原发性肺adc的敏感性/特异性分别为0.960/0.732、0.858/0.934、0.972/0.733，对转移性肺adc的敏感性/特异性分别为0.992/0.642、0.878/0.881、0.993/0.618。我们的研究表明，IHC标记物在原发性和转移性ADC和SqCC的亚分类中具有不同的敏感性和特异性。基于形态学发现，一种结合标记的算法有助于在困难病例中进行非小细胞肺癌的亚分类。
Fine needle aspiration (FNA) biopsy plays a critical role in the diagnosis and staging of lung primary and metastatic lung carcinoma. Accurate subclassification of adenocarcinoma (ADC) and/or squamous cell carcinoma (SqCC) is crucial for the targeted therapy. However, the distinction between ADC and SqCC may be difficult in small FNA specimens. Here, we have retrospectively evaluated the utility of TTF-1, Napsin A, CK7, P63 and CK5/6 immunohistochemical (IHC) markers in the distinguishing and subclassification of ADC and SqCC. A total of 246 FNA cases were identified by a computer search over a two-year period, including 102 primary NSCLC and 144 primary NSCLC which had metastasized to other sites. The immunostaining patterns of TTF-1, Napsin A, CK7, P63 and CK5/6 were correlated with the histological diagnosis of the tumor. In 72 primary ADCs, TTF-1, Napsin A and CK7 showed a sensitivity and specificity of 84.5%/96.4%, 92.0%/100%, and 93.8%/50.0%. In 30 primary SqCCs, CK5/6 and P63 showed a sensitivity and specificity of 100%/77.8% and 91.7%/78.3%. In 131 metastatic ADCs, Napsin A showed the highest specificity (100%), versus TTF-1 (87.5%) and CK7 (25%) but decreased sensitivity (67.8% versus 86.9% and 100%); whereas in 13 metastatic SqCCs, CK5/6 and P63 showed a sensitivity/specificity of 100%/84.6% and 100%/68.4%. Bootstrap analysis showed that the combination of TTF-1/CK7, TTF-1/Napsin A and TTF-1/CK7/Napsin A had a sensitivity/specificity of 0.960/0.732, 0.858/0.934, 0.972/0.733 for primary lung ADCs and 0.992/0.642, 0.878/0.881, 0.993/0.618 for metastatic lung ADCs. Our study demonstrated that IHC markers had variable sensitivity and specificity in the subclassification of primary and metastatic ADC and SqCC. Based on morphological findings, an algorithm with the combination use of markers aided in the subclassification of NSCLCs in difficult cases.