Napsin A is useful to distinguish primary lung adenocarcinoma from adenocarcinomas of other organs

Suzuki, Akihiro; Shijubo, Noriharu; Yamada, Gen; Ichimiya, Shingo; Satoh, Masaaki; Abe, Shosaku; Sato, Noriyuki

doi:10.1016/j.prp.2005.05.010

Cited by 79 publications

(78 citation statements)

References 19 publications

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“…Two studies reported Napsin A expression in 84.3 and 90.7% of lung adenocarcinomas whereas squamous cell carcinoma was completely negative. 46,47 These two studies also examined a total of 14 mammary carcinomas and none of the cases expressed Napsin A. 46,47 None of the 115 mammary carcinomas in our study expressed this marker, either.…”

Section: Discussionmentioning

confidence: 66%

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A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

2010

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The risk of developing a second primary cancer is increased in patients with breast cancer, and the lung is one of the major sites involved. Moreover, the lung is the major metastatic site for breast cancers. A distinction between metastatic breast cancer and primary lung cancer can be histologically difficult, and both show an overlapping CK7 þ /CK20À immunoprofile in a majority of cases. The degree of difficulty increases with poorly differentiated tumors. We investigated differential expressions of TTF-1, Napsin A, surfactant apoprotein A, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 immunostains in 197 pulmonary carcinomas (158 adenocarcinomas, 39 squamous) and 115 invasive mammary carcinomas (91 ductal, 24 lobular type). In mammary carcinomas, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 were expressed in 74, 72, 64, and 62%, respectively, whereas TTF-1, Napsin A, and surfactant apoprotein A were all negative. The expressions were diffuse in estrogen receptor and GATA-3, and variable in mammaglobin and GCDFP-15. For a combination of estrogen receptor/mammaglobin or GATA-3/mammaglobin, 83% of mammary carcinomas were positive, and the detection rate was not improved by using all three markers. All lung squamous cell carcinomas were negative for all markers studied. TTF-1, Napsin A, and surfactant apoprotein A were positive in 80, 77, and 45% of pulmonary adenocarcinomas. None of the TTF-1-negative tumors expressed surfactant apoprotein A. GCDFP-15 was focally expressed in 2.5% of pulmonary adenocarcinomas, and estrogen receptor was focally expressed in one case (1.2%) of pulmonary adenocarcinoma. When metastasis from breast cancer is suspected in the lung, a combination of either estrogen receptor/mammaglobin or GATA-3/mammaglobin as breast markers, and a combination of TTF-1 and Napsin A as lung markers may be helpful for differentiating between the two. Caution should be taken in the interpretation of GCDFP-15 due to its occasional expression in pulmonary adenocarcinomas.

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Section: Discussionmentioning

confidence: 66%

“…46,47 These two studies also examined a total of 14 mammary carcinomas and none of the cases expressed Napsin A. 46,47 None of the 115 mammary carcinomas in our study expressed this marker, either. Our results indicate that the sensitivity of Napsin A in pulmonary adenocarcinoma is comparable to that of TTF-1.…”

Section: Discussionmentioning

confidence: 66%

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

2010

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“…Only one metastasis of a renal carcinoma origin expressed napsin, while none of the other types of tumors expressed napsin. suzuki et al (13) showed that napsin A was expressed in almost all tumor cells in most primary lung adenocarcinoma specimens (84.3%, 70/83). Its expression was not observed in any of the 32 metastatic lung tumors (colon, stomach, breast, uterus, thyroid and submandibular gland), nor in any of the primary sites of adenocarcinoma of other organs (stomach, colon, breast and thyroid).…”

Section: Discussionmentioning

confidence: 99%

Value of napsin A and thyroid transcription factor-1 in the identification of primary lung adenocarcinoma

Zhang

Han²,

Huang³

et al. 2010

Oncology Letters

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Abstract. napsin A is a newly discovered functional aspartic proteinase that is expressed in normal lung parenchyma in type Ⅱ pneumocytes and is thought to be associated with primary lung adenocarcinoma. thyroid transcription factor-1 (ttF-1) is a widely used relatively restricted marker for lung adenocarcinoma. the present study aimed to compare the usefulness of napsin A with TTF-1 for the identification of primary lung adenocarcinoma. Immunohistochemical expression of napsin A and ttF-1 was analyzed in 351 lung cancer tissues, including 27 metastases. napsin A was expressed in 180 of 212 (84.9%) primary lung adenocarcinomas, while no expression was noted in all 27 metastatic lung cancer specimens, including 19 metastatic adenocarcinomas. In contrast, ttF-1 expression was not only noted in 179 of 212 (84.4%) primary lung adenocarcinomas, but also in 12 of 18 (66.7%) small-cell carcinomas and some of the squamous carcinomas, as well as in one metastatic adenocarcinoma from the thyroid. the sensitivity and specificity of napsin A for primary lung adenocarcinoma (84.9 and 93.8%, respectively) were higher than the sensitivity and specificity of TTF-1 (84.4 and 83.9%, respectively). By combining napsin A and TTF-1, sensitivity increased to 91.0%. Furthermore, the sensitivity and specificity expression was associated with gender, smoking history, performance status, pathological type, primary tumor size and nodal metastasis. therefore, napsin A is a useful novel marker in the differential diagnosis of primary lung adenocarcinoma.

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“…Studies using a monoclonal napsin A antibody to distinguish primary pulmonary from nonpulmonary tumors have reported high specificity. 5,11,12,14 We used a polyclonal napsin A antibody and observed decreased specificity, with napsin A expressed in 48% of extrapulmonary mucinous tumors. One other study has used the same polyclonal antibody used in our study, although with different results.…”

Section: 711-13mentioning

confidence: 99%

“…4 Thus, it is a useful marker for subclassification of non-small cell carcinoma of the lung and for distinguishing primary ACA of lung from metastatic ACA. [5][6][7] Mucinous tumors of the lung are uncommon and comprise a heterogeneous group of neoplasms that, according to the most recent classification proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society, 8 include mucinous ACA (MA), solid predominant ACA with mucin production, and colloid ACA. The classification further subdivides MA depending on the extent of lepidic versus invasive growth pattern into MA in situ, mucinous minimally invasive ACA, or invasive MA (formerly classified as mucinous bronchioloalveolar carcinoma according to the 2004 World Health Organization classification scheme).…”

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confidence: 99%

Polyclonal Napsin A Expression: A Potential Diagnostic Pitfall in Distinguishing Primary From Metastatic Mucinous Tumors in the Lung

Heymann

Hoda

Scognamiglio

2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Napsin A is a useful marker for distinguishing primary from metastatic lung tumors. Mucinous lung tumors may be difficult to distinguish from metastatic mucinous tumors.Objectives.-To evaluate napsin A expression in lung and extrapulmonary mucinous tumors on both histology and cytology specimens and to determine napsin A's utility in differentiating primary from metastatic mucinous tumors.Design.-Napsin A immunohistochemistry was performed using a rabbit polyclonal antibody on formalinfixed, paraffin-embedded surgical and fine-needle aspiration biopsy-derived, paraffin-embedded cell block specimens. Positive expression was defined as coarse, granular, cytoplasmic staining in 10% or more of tumor cells.Results.-Sixteen of 32 mucinous lung tumors (50%) and 16 of 33 extrapulmonary mucinous tumors (48%), including 15 of 18 of gastrointestinal origin (83%), expressed napsin A. Positivity was concordant between surgical and cell block specimens in 5 of 9 cases (56%). In 3 of 4 discordant cases, napsin A expression was detected on the surgical specimen but not the cell block. The cell block material in these cases was paucicellular.Conclusions.-Napsin A shows decreased sensitivity and specificity for mucinous lung tumors and is unlikely to be reliable as a sole immunohistochemical marker of lung origin for such tumors (52% specificity in this study). The high frequency of napsin A expression in gastrointestinal mucinous tumors makes it particularly unreliable in distinguishing metastatic gastrointestinal from primary lung mucinous tumors. However, napsin A expression analysis may facilitate distinguishing mucinous tumors of pulmonary from those of nongastrointestinal origin. Interpretation of napsin A staining may be problematic in mucinous tumor specimens of low cellularity such as cell blocks.

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Napsin A is useful to distinguish primary lung adenocarcinoma from adenocarcinomas of other organs

Cited by 79 publications

References 19 publications

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

Value of napsin A and thyroid transcription factor-1 in the identification of primary lung adenocarcinoma

Polyclonal Napsin A Expression: A Potential Diagnostic Pitfall in Distinguishing Primary From Metastatic Mucinous Tumors in the Lung

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