Value of P63 and CK5/6 in distinguishing squamous cell carcinoma from adenocarcinoma in lung fine‐needle aspiration specimens
- 23 January 2009
- journal article
- research article
- Published by Wiley in Diagnostic Cytopathology
- Vol. 37 (3), 178-183
- https://doi.org/10.1002/dc.20975
Abstract
The current FDA‐approved standard of care for nonsmall cell lung cancer is Carboplastin/Taxol/Avastin based upon an impressive survival benefit; however, patients with squamous carcinoma (SQCC) cannot receive Avastin because of a 30% mortality rate due to fatal hemoptysis. In this study we evaluated the role of cytomorphology and immunohistochemistry in differentiating SQCC from adenocarcinoma (ADC) in lung FNA specimens. The case cohort included 53 FNA cases of nonsmall cell lung carcinoma with surgical pathology follow‐up. All FNA specimens were reviewed independently by a panel of cytopathologists to differentiate between SQCC and ADC. The cell block material was available in 23 cases (11 ADC and 12 SQCC) to perform immunohistochemical stains for TTF‐1, CK7, CK20, P63, and CK5/6. On surgical resection, 35/53 (66%) cases were diagnosed as ADC and 18/53 (34%) as SQCC. The number of cases classified correctly on the basis of cytomorphology was 66% for ADC and 53% for SQCC (combined accuracy 60%). By immunohistochemical staining, 14/23 (61%) cases expressed TTF‐1. Nine cases were TTF‐1 negative; eight of the TTF‐1 negative cases (89%) were SQCC. Twenty‐three cases expressed CK7 (87%); one ADC case (4%) showed focal CK20 positivity. Both P63 and CK5/6 expression was seen in 9/12 (75%) SQCC cases; none of the ADC cases showed this dual expression. Cytomorphology alone may not be able to stratify all cases of nonsmall cell lung carcinoma into ADC and SQCC in FNA specimens. The immune‐panel of TTF‐1, CK7, CK20, P63, and CK5/6 is useful in differentiating SQCC from ADC. Diagn. Cytopathol. 2009.Keywords
This publication has 19 references indexed in Scilit:
- Utility of WT‐1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusionsDiagnostic Cytopathology, 2007
- Phase II Study of Efficacy and Safety of Bevacizumab in Combination With Chemotherapy or Erlotinib Compared With Chemotherapy Alone for Treatment of Recurrent or Refractory Non–Small-Cell Lung CancerJournal of Clinical Oncology, 2007
- Bevacizumab in Non–Small Cell Lung CancerClinical Cancer Research, 2007
- Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitors Vandetanib (ZD6474) and AZD2171 in Lung CancerClinical Cancer Research, 2007
- FDA Drug Approval Summary: Bevacizumab (Avastin®) Plus Carboplatin and Paclitaxel as First-Line Treatment of Advanced/Metastatic Recurrent Nonsquamous Non-Small Cell Lung CancerThe Oncologist, 2007
- Paclitaxel–Carboplatin Alone or with Bevacizumab for Non–Small-Cell Lung CancerThe New England Journal of Medicine, 2006
- TTF-1 and p63 for distinguishing pulmonary small-cell carcinoma from poorly differentiated squamous cell carcinoma in previously pap-stained cytologic materialLaboratory Investigation, 2006
- Distinction of pulmonary small cell carcinoma from poorly differentiated squamous cell carcinoma: an immunohistochemical approachLaboratory Investigation, 2005
- Randomized Phase II Trial Comparing Bevacizumab Plus Carboplatin and Paclitaxel With Carboplatin and Paclitaxel Alone in Previously Untreated Locally Advanced or Metastatic Non-Small-Cell Lung CancerJournal of Clinical Oncology, 2004
- p63 and TTF-1 Immunostaining: A Useful Marker Panel for Distinguishing Small Cell Carcinoma of Lung From Poorly Differentiated Squamous Cell Carcinoma of LungAmerican Journal of Clinical Pathology, 2003