Correlation of immunohistochemical staining p63 and TTF-1 with EGFR and K-ras mutational spectrum and diagnostic reproducibility in non small cell lung carcinoma.
For treatment purposes, distinction between squamous cell carcinoma and adenocarcinoma is important. The aim of this study is to examine the diagnostic accuracy on lung cancer small biopsies for the distinction between adenocarcinoma and squamous cell carcinoma and relate these to immunohistochemical and KRAS and EGFR mutation analysis. An interobserver study was performed on 110 prospectively collected biopsies obtained by bronchoscopy or transthoracic needle biopsy of patients with non-small cell lung cancer. The diagnosis was correlated with immunohistochemical (IHC) analysis for markers of adeno- (TTF1 and/or mucin positivity) and squamous cell differentiation (P63 and CK5/6) as well as KRAS and EGFR mutation analysis. Eleven observers independently read H&E-stained slides of 110 cases, resulting in a kappa value of 0.55 ± 0.10. The diagnosis non-small cell lung cancer not otherwise specified was given on average on 29.5 % of the biopsies. A high concordance was observed between hematoxylin-eosin-based consensus diagnosis (≥8/11 readings concordant) and IHC markers. In all cases with EGFR (n = 1) and KRAS (n = 20) mutations, adenodifferentiation as determined by IHC was present and p63 staining was absent. In 2 of 25 cases with a consensus diagnosis of squamous cell carcinoma, additional stainings favored adenodifferentation, and a KRAS mutation was present. P63 is most useful for distinction between EGFR/KRAS mutation positive and negative patients. In the diagnostic work-up of non-small cell lung carcinoma the limited reproducibility on small biopsies is optimized with immunohistochemical analysis, resulting in reliable delineation for predictive analysis.
Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. e.thunnissen@vumc.nl
Erik
E
Thunnissen
Evan
E
Boers
Daniëlle A M
DA
Heideman
Katrien
K
Grünberg
Dirk J
DJ
Kuik
Arnold
A
Noorduin
Matthijs
M
van Oosterhout
Divera
D
Pronk
Cees
C
Seldenrijk
Hannie
H
Sietsma
Egbert F
EF
Smit
Robertjan
R
van Suylen
Jan
J
von der Thusen
Bart
B
Vrugt
Anne
A
Wiersma
Birgit I
BI
Witte
Michael
M
den Bakker
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D004252:DNA Mutational Analysis; D004801:Eosine Yellowish-(YS); D066246:ErbB Receptors / Q000235:genetics*; D006416:Hematoxylin; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008175:Lung Neoplasms / Q000473:pathology*; D008565:Membrane Proteins / Q000032:analysis*; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000235:genetics*; D016283:Proto-Oncogene Proteins p21(ras); D015203:Reproducibility of Results; D013194:Staining and Labeling; D014157:Transcription Factors / Q000032:analysis*; D018631:ras Proteins / Q000235:genetics*
C511144:CCDC59 protein, human; C081876:CKAP4 protein, human; C117307:KRAS protein, human; D008565:Membrane Proteins; D011518:Proto-Oncogene Proteins; D014157:Transcription Factors; C512478:EGFR protein, human; D066246:ErbB Receptors; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin