title: Tissue-sparing application of the newly proposed IASLC/ATS/ERS classification of adenocarcinoma of the lung shows practical diagnostic and prognostic impact.
abstract: The histologic subtype of non-small cell lung cancer (NSCLC) determines treatment strategies and the need for genetic analyses. Since most NSCLC are diagnosed on small biopsy or cytologic specimens, an accurate but tissue-sparing approach is necessary. To date, consensus for a general diagnostic algorithm is lacking. To test the diagnostic and clinical relevance of the recently published multidisciplinary guidelines by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society, we examined 371 surgically resected NSCLCs brought into tissue microarray format. The antibody panel thyroid transcription factor-1 (TTF-1), p63, cytokeratin (CK)5/6, and CK7 is diagnostic for most cases (>94%). Faint/focal staining for CK7 is negligible for classificatory purposes. Grading adenocarcinomas according to histologic architecture is prognostically significant (median overall survival for well/moderate differentiation, 72.5 months; for poor differentiation, 38.5 months; P = .019). Double stains combining the aforementioned nuclear and membranous markers are highly diagnostic for NSCLC, conserving tumor tissue for subsequent analyses.
authors.affiliation: Academic Hospital Feldkirch, Affiliation of the Medical University Innsbruck, Institute for Pathology, Carinagasse 47, 6807 Feldkirch, Austria.
authors.forename: William
authors.initials: W
authors.lastname: Sterlacci
authors.forename: Spasenija
authors.initials: S
authors.lastname: Savic
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmid
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Oberaigner
authors.forename: Jutta
authors.initials: J
authors.lastname: Auberger
authors.forename: Michael
authors.initials: M
authors.lastname: Fiegl
authors.forename: Alexandar
authors.initials: A
authors.lastname: Tzankov
mesh_terms: D000230:Adenocarcinoma / Q000145:classification* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004268:DNA-Binding Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D053555:Keratin-5 / Q000378:metabolism; D053553:Keratin-6 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012680:Sensitivity and Specificity; D014157:Transcription Factors / Q000378:metabolism; D025521:Tumor Suppressor Proteins / Q000378:metabolism; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C503940:KRT5 protein, human; D053555:Keratin-5; D053553:Keratin-6; D053552:Keratin-7; C115051:TP63 protein, human; C504003:TTF1 protein, human; D014157:Transcription Factors; D025521:Tumor Suppressor Proteins