Refining the Diagnosis and EGFR Status of Non-small Cell Lung Carcinoma in Biopsy and Cytologic Material, Using a Panel of Mucin Staining, TTF-1, Cytokeratin 5/6, and P63, and EGFR Mutation Analysis

Nicholson, Andrew G.; González, David; Shah, Pallav L.; Pynegar, Matthew J.; Deshmukh, Manjiri A; Rice, Alexandra; Popat, Sanjay

doi:10.1097/jto.0b013e3181c6ed9b

Cited by 194 publications

(198 citation statements)

References 23 publications

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“…5 Similarly, 34bE12 stains not only 100% of poorly differentiated squamous cell carcinomas but also 60% of poorly differentiated adenocarcinomas. 5,12 Therefore, positivity for either CK7 or 34bE12 is of no utility for non-small cell lung 5 b Alternative term: non-small cell lung carcinoma, not otherwise specified (NSCLC, NOS); review H&E morphology, consider diagnoses other than carcinoma. Figure 4 Immunohistochemical staining in poorly differentiated adenocarcinoma.…”

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confidence: 99%

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Utility of small biopsies for diagnosis of lung nodules: doing more with less

Mukhopadhyay

2012

Modern Pathology

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Small biopsies obtained by core needle or bronchoscopy are commonly used for diagnosis of lung nodules. This review provides guidance in two key areas of interpretation of small lung biopsies. The first part answers common questions regarding the immunohistochemical subclassification of non-small cell lung carcinomas that cannot be classified by standard criteria on hematoxylin-eosin-stained sections of small lung biopsies. The second part discusses common benign entities that can be diagnosed in core needle biopsies of lung nodules, such as granulomatous inflammation, parenchymal scars and organizing pneumonia. The approach to cases in which malignant cells are absent and features of a specific benign diagnosis are lacking is also addressed.

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confidence: 99%

“…6,12 However, we do not use mucin stains in our panel as significant amounts of mucin are usually well visualized on H&E-stained sections. Furthermore, mucin stains lack sensitivity for poorly differentiated adenocarcinomas (23%) 6 when compared with TTF-1 or napsin A (80 and 58%, respectively).…”

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confidence: 99%

Utility of small biopsies for diagnosis of lung nodules: doing more with less

Mukhopadhyay

2012

Modern Pathology

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“…18 Immunohistochemical markers for SqCC include p63, CK5/6, cytokeratin 34bE12 (CK903), and p40. The p63 antibody, with numerous studies showing excellent sensitivity as a marker for SqCC, [19][20][21] has long been the most commonly used nuclear marker for squamous origin. However, p63 has been shown to be positive in 16% to 65% of lung adenocarcinoma 20,[22][23][24] and in 55 of 172 cases (32%) of diffuse large B cell lymphoma.…”

Section: Primary Epithelial Tumors Of Lungmentioning

confidence: 99%

Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms

Woo¹,

Reddy²,

Koo³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-A vast majority of neoplasms arising from lung or pleura are initially diagnosed based on the histologic evaluation of small transbronchial, endobronchial, or needle core biopsies. Although most diagnoses can be determined by morphology alone, immunohistochemistry can be a valuable diagnostic tool in the workup of problematic cases.Objective.-To provide a practical approach in the interpretation and immunohistochemical selection of lung/ pleura-based neoplasms obtained from small biopsy samples.Data Sources.-A literature review of previously published articles and the personal experience of the authors were used in this review article.Conclusion.-Immunohistochemistry is a useful diagnostic tool in the workup of small biopsies from the lung and pleura sampled by small biopsy techniques.

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“…Possibilities include increased use of immediate specimen evaluation for adequacy by pathologists and the use of novel specimen-preservation techniques. 3,6 One need only to examine the success of reflex human papilloma virus (HPV) testing in liquid-based collections in cervical-vaginal screening to see how alterations in cytologic methods can be used to enhance patient care in the setting of new epidemiologic and molecular knowledge of a common disease. Although EGFR and KRAS represent the ''now'' of molecular testing in NSCLC, the field of targeted therapy is rapidly evolving and, ideally, residual material in cytologic specimens will be available for future retrospective testing as new agents become available.…”

Section: What Molecular Information Do Oncologists Need To Treat Advamentioning

confidence: 99%

“…The use of ancillary studies, such as p63 (squamous cell marker) and TTF-1 (thyroid transcription factor 1, also known as NKX2-1, a marker of pulmonary adenocarcinoma) have been advocated by some as a surrogate for morphologic classification. 3 The key question becomes, ''Should limited material be sacrificed for this type of ancillary testing to determine eligibility for a single, expensive, treatment modality?'' Perhaps this question is better addressed by asking another question, ''Does a generic diagnosis of socalled 'NSCLC' preclude the patient from being evaluated for surgical therapy, radiation therapy, or chemotherapy?''…”

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confidence: 99%

Neoplastic pulmonary cytology

Cohen

Weydert

2010

Cancer Cytopathology

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The recent accumulation of epidemiologic and molecular research focused on nonsmall cell lung cancer (NSCLC) in combination with the development of novel/targeted therapies has caused pathologists to critically evaluate the issue of the histologic subclassification of such tumors. The use of the generic term NSCLC, once fully endorsed and accepted by our oncology colleagues, has recently been taken to task, and we are being asked, ''Can you tell if it is a squame or an adeno?'' by our clinical partners on a routine basis. This shift in framework in the diagnostic reporting of lung cancer poses practical challenges in the arena of diagnostic pulmonary cytology. Although cytology is an excellent discriminator of small cell carcinoma versus nonsmall cell carcinoma, it is less reliable in the subclassification of NSCLC. 1 Furthermore, we are being asked to provide molecular-level information on small biopsy specimens (epidermal growth factor receptor [EGFR] gene mutations, KRAS gene mutation, ALK-EML4 gene fusion, etc), which is even more problematic for many cytologic specimens (aspirates, brushes, washes) that may have very limited residual specimen for testing. How does all this impact the day to day sign out of pulmonary cytology specimens? A few points for consideration are presented below. The reader can draw his or her own conclusions, and we will welcome a spirited and critical debate in this journal.1. What are the most important goals of sampling a pulmonary mass via aspiration or exfoliative cytology techniques?The primary goal is to establish, with certainty, the biologic nature of the mass; benign (eg, inflammatory) versus malignant. If a lesion can be placed into the ''malignant'' category, then the second objective is to determine whether it is a primary or metastatic lesion. Ancillary studies, such as immunocytochemistry, can be very helpful in this regard, particularly when the clinical picture is unclear, and are worthwhile uses of residual material. When the lesion is a primary lung tumor, the distinction between small cell and nonsmall cell histology is important for proper classification. These diagnostic objectives have not changed despite the molecular-driven changes in pulmonary oncologic practice.2. What is the clinical significance of distinguishing NSCLC subtypes on cytologic specimens? The principal (albeit not sole) driver of the interest in specifying subtypes of NSCLC in pathology reports is the advent of bevacizumab (Avastin), a vascular endothelial growth factor (VEGF) receptor inhibitor, as a treatment of NSCLC. Briefly, bevacizumab was found to have an unacceptable risk of life-threatening pulmonary hemorrhage in patients who have squamous cell (compared with nonsquamous cell) morphology. Data on

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Refining the Diagnosis and EGFR Status of Non-small Cell Lung Carcinoma in Biopsy and Cytologic Material, Using a Panel of Mucin Staining, TTF-1, Cytokeratin 5/6, and P63, and EGFR Mutation Analysis

Cited by 194 publications

References 23 publications

Utility of small biopsies for diagnosis of lung nodules: doing more with less

Utility of small biopsies for diagnosis of lung nodules: doing more with less

Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms

Neoplastic pulmonary cytology

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