Thyroid transcription factor-1 is highly sensitive and specific in differentiating metastatic pulmonary from extrapulmonary adenocarcinoma in effusion fluid cytology specimens.
BACKGROUND
Thyroid transcription factor-1 (TTF-1) is a homeodomain-containing transcription factor selectively expressed in thyroid, lung and diencephalon. It has been shown to label pulmonary adenocarcinoma, thyroid tumors, and small cell carcinoma (pulmonary and extrapulmonary) with relatively high sensitivity and specificity. The usefulness of this immunostain in cytology specimens has not been thoroughly discussed in the literature.


METHODS
The authors evaluated 36 effusion cytology cases (17 pleural effusion, 18 ascitic fluid, and 1 pericardial effusion) diagnosed as metastatic adenocarcinoma and with cell blocks prepared from the file of Pamela Youde Nethersole Eastern Hospital, Hong Kong, during a three-year period from 1998 to early 2001. The clinical, radiologic, cytologic, and histologic (if any) findings were reviewed. A provisional diagnosis of the primary site was deduced for each of the 36 cases by clinical, radiologic, and/or histologic correlation. Immunohistochemical study was performed on the cell block sections of the effusion cytology specimens using mouse monoclonal antibody against TTF-1, after microwave heat-antigen retrieval. The results were correlated with the primary origin of the metastatic adenocarcinoma.


RESULTS
Among the 17 cases of metastatic pulmonary adenocarcinoma, 15 cases showed nuclear staining for TTF-1 in most of the tumor cells (sensitivity, 88.2%). None of the 19 cases of metastatic extrapulmonary adenocarcinoma expressed TTF-1 (specificity, 100%).


CONCLUSIONS
The current study validates TTF-1 as a highly sensitive and specific immunomarker for distinguishing between metastatic pulmonary and extrapulmonary adenocarcinoma in effusion cytology specimens, which are known to be associated with intrinsic artifact due to less than ideal cellular preservation.
Ng
W K
WK
Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. ngwk@yahoo.com
Chow
Janson C Y
JC
Ng
Peter K H
PK
D000230:Adenocarcinoma / Q000175:diagnosis / Q000276:immunology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D001201:Ascites; D014408:Biomarkers, Tumor / Q000032:analysis*; D002467:Cell Nucleus; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000556:secondary*; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D009687:Nuclear Proteins / Q000032:analysis*; D010490:Pericardial Effusion / Q000737:chemistry; D016066:Pleural Effusion, Malignant / Q000737:chemistry; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors / Q000032:analysis*
D014408:Biomarkers, Tumor; C000614412:NKX2-1 protein, human; C000614414:Nkx2-1 protein, mouse; D009687:Nuclear Proteins; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors