title: The utility of a novel triple marker (combination of TTF1, napsin A, and p40) in the subclassification of non-small cell lung cancer.
abstract: In lung cancer, targeted therapies depend on accurate histological subclassification of the tumor. The majority of lung cancers can be subclassified based on hematoxylin and eosin staining; however, classification may be difficult in small biopsies. In this study, we investigated the utility of a newly developed triple marker (combination of TTF1/Napsin A/p40) and compared the sensitivity and specificity of this novel marker with individual markers in the subclassification of non-small cell lung carcinomas. Lung cancer tissue microarrays were constructed using surgical resection material from the Johns Hopkins Hospital. They included 77 adenocarcinomas (ADCs), 77 squamous cell carcinomas (SqCCs), and 46 cases of metastatic lung ADCs. Immunostaining patterns of all markers were scored semi-quantitatively and compared. In ADCs, the sensitivity and specificity of the triple marker were 93.5% and 77.5%, respectively. The sensitivity and specificity of TTF1 and Napsin A were 85.7% and 75.0%, and 89.6% and 90.0%. In SqCCs, the sensitivity and specificity of the triple marker were 88.3% and 92.5%, while the p40, p63 and CK5/6 showed 80.5% and 90.0%; 93.5% and 80.0%; and 89.6% and 80.0%. In addition, the sensitivity and specificity of the triple marker in metastatic ADCs showed 71.7% and 73.5%, respectively. Our triple marker (combination of TTF1/Napsin A/p40) showed a similar sensitivity and specificity for the subclassification of NSCLC when compared to individual markers. Our study not only demonstrates a useful combination of immunomarkers but also optimally conserves tissue for molecular marker testing.
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Ao
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Lynne
authors.initials: L
authors.lastname: Sakowski
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Rajni
authors.initials: R
authors.lastname: Sharma
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Illei
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Gabrielson
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
authors.forename: Frederic
authors.initials: F
authors.lastname: Askin
authors.affiliation: The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA. Electronic address: qli23@jhmi.edu.
authors.forename: Qing Kay
authors.initials: QK
authors.lastname: Li
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology / Q000556:secondary; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000369:Aged, 80 and over; D016282:Aspartic Acid Endopeptidases / Q000032:analysis*; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000473:pathology; D004268:DNA-Binding Proteins / Q000032:analysis*; D005260:Female; D006801:Humans; D016056:Immunodominant Epitopes / Q000032:analysis*; D008175:Lung Neoplasms / Q000145:classification* / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis*; D012680:Sensitivity and Specificity; D014157:Transcription Factors
chemical_list: D004268:DNA-Binding Proteins; D016056:Immunodominant Epitopes; C495942:P40, iodinated C-terminal peptide, human; D010446:Peptide Fragments; C504003:TTF1 protein, human; D014157:Transcription Factors; D016282:Aspartic Acid Endopeptidases; C498549:NAPSA protein, human
keywords: Immunohistochemical markers; Napsin A; Non–small cell lung carcinoma (NSCLC); Novel triple stain marker; P40
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