Evaluation of Napsin A, Cytokeratin 5/6, p63, and Thyroid Transcription Factor 1 in Adenocarcinoma Versus Squamous Cell Carcinoma of the Lung
Evaluation of Napsin A, Cytokeratin 5/6, p63, and Thyroid Transcription Factor 1 in Adenocarcinoma Versus Squamous Cell Carcinoma of the Lung
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DOI：
10.5858/arpa.2011-0232-oa
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Jagirdar, Jaishree
中科院分区：
文献类型：
--
作者：
Whithaus, Kenneth;Fukuoka, Junya;Jagirdar, Jaishree
背景。肺腺癌与其他类型的原发性肺恶性肿瘤的区别在临床上是重要的。由于70%的肺癌是在有限的细针穿刺或经支气管活检标本上诊断的，因此准确的形态学分类常常受到阻碍。虽然甲状腺转录因子1（TTF-1）历来是肺腺癌最特异的标志物，但最近发现一种相对较新的标志物napsin A比TTF-1更敏感和特异。寻找最具成本效益的面板，以可靠地区分肺腺癌和鳞状细胞癌。共对291例肺癌进行了形态学评价（197例腺癌[75%]; 66例鳞状细胞癌[25%]; 28例无法归类为任何一种，因此被剔除）。在从日本富山获得的福尔马林固定的组织微阵列上进行napsin A、细胞角蛋白5/6、p63和TTF-1的免疫组织化学。病例被分为阳性或阴性对照。Napsin A对腺癌的敏感性为83%，特异性为98%，TTF-1对腺癌的敏感性为60%，特异性为98%。细胞角蛋白5/6的敏感性为53%，特异性为96%，p63的敏感性为95%，特异性为86%。一组napsin A和p63的特异性为94%，敏感性为96%，用于区分腺癌和鳞状细胞癌。抗体的来源对于避免假阴性结果很重要。在肺腺癌与鳞状细胞癌的鉴别诊断中，小活检标本的最具成本效益的组织保留组是p63和napsin A的组合。(Arch 2012;136：155-162; doi：10.5858/arpa.2011-0232-OA）
Context.-The distinction of lung adenocarcinoma from other types of primary lung malignancies is important clinically. Accurate morphologic classification is often hindered because 70% of lung cancers are diagnosed on limited fine-needle aspiration or transbronchial biopsy specimens. Although thyroid transcription factor 1 (TTF-1) has historically been the most specific marker for lung adenocarcinoma, a relatively new marker, napsin A, has recently been shown to be more sensitive and specific than TTF-1.Objective.-To find the most cost-effective panel to reliably distinguish lung adenocarcinoma from squamous cell carcinoma.Design.-A total of 291 lung cancers were evaluated morphologically (197 adenocarcinomas [75%]; 66 squamous cell carcinomas [25%]; 28 cases could not be classified into either and were dropped). Immunohistochemistry for napsin A, Cytokeratin 5/6, p63, and TTF-1 was performed on a formalin-fixed tissue microarray obtained from Toyama, Japan. Cases were scored as positive or negative against a negative control.Results.-Napsin A had 83% sensitivity and 98% specificity and TTF-1 had 60% sensitivity and 98% specificity for adenocarcinoma. Cytokeratin 5/6 had 53% sensitivity and 96% specificity and p63 had 95% sensitivity and 86% specificity for squamous cell carcinoma. A panel of napsin A and p63 has a specificity of 94% and a sensitivity of 96% for distinguishing adenocarcinoma from squamous cell carcinoma.Conclusions.-The source of the antibody is important in avoiding false-negative results. The most cost-effective tissue-preserving panel for small biopsy specimens in the differential diagnosis of lung adenocarcinoma versus squamous cell carcinoma is a combination of p63 and napsin A. (Arch Pathol Lab Med. 2012;136:155-162; doi: 10.5858/arpa.2011-0232-OA)