Limited Immunohistochemistry Panel in Subclassification of Poorly Differentiated Non-Small Cell Lung Carcinoma in a Scarce Resource Setup

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Limited Immunohistochemistry Panel in Subclassification of Poorly Differentiated Non-Small Cell Lung Carcinoma in a Scarce Resource Setup

Rabiya Fawad, Maryam Qaiser, Ashok Kumar Tanwani, Ahmareen Khalid Sheikh and Saira Javed

Department of Pathology, Pakistan Institute of Medical Sciences, SZABMU, Islamabad

Abstract:

Background: With the emergence of targeted therapies for non-small cell lung carcinoma with different efficacy and toxicity, differentiating between adenocarcinoma and squamous cell carcinoma in lung biopsies has become essential. In cases of poorly differentiated non-small cell lung carcinoma standard haematoxylin and eosin stained morphology cannot confidently subtype the tumour as adenocarcinoma and squamous cell. In these cases, limited panel of immunohistochemical markers including TTF-1, CK7 and p63 may serve as a useful tool to specify the subtype of lung carcinoma in a resource limited setup.

Objectives: The aim of this study is to see the expression of IHC markers TTF-1, CK7 and p63 in poorly differentiated NSCLC and its importance in subtyping NSCLC as ADC & SCC in lung biopsy specimens.

Methods: It was a Cross sectional study, conducted at Department of Pathology, SZABMU, PIMS Islamabad for a period of 12 months (September 2015 to August 2016). A total of 51 lung biopsies with poorly differentiated NSCLC were further stained with the IHC markers TTF-1, CK 7 and p63. Statistical analysis was performed using SPSS Version 21.

Results: The mean age was 59±14 years with a male to female ratio of 2:1. 26 males (51%) and 5 females (9.8%) out of the total 51 cases were smokers. 41.2% cases expressed positivity for TTF-1, 39.2% for p63 and 51% were positive for CK7 staining. 80.4% of cases were sub-typed as ADC and SCC by using this panel of immunomarkers. 19.6% of cases were categorized as poorly differentiated carcinoma.

Conclusion: Limited panel of IHC markers comprising of TTF1, p63 and CK7 can subtype a substantial percentage (80.4%) of poorly differentiated NSCLC.



         

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