Subclassification of Non-Small Cell Lung Cancer by Cytologic Sampling: A Logical Approach with Selective Use of Immunocytochemistry

Kimbrell, Hillary Z.; Gustafson, Karen S.; Huang, Min; Ehya, Hormoz

doi:10.1159/000338519

Cited by 12 publications

(13 citation statements)

References 62 publications

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“…Best Practices: Diagnostic IHC in Lung Cancer lung adenocarcinoma, ranging from 92% to 100%, thus contrasting with its low specificity (ranging from 50% to 93%) when compared with other markers such as napsin A and TTF1 (Table 5). 18,[30][31][32][33][34][35][36][37][38][39] Indeed, according to a recent series, 5% to 77% (mean 25%) of squamous cell carcinoma can display CK7 staining ( Fig. 4) that is often weaker than the staining observed in adenocarcinoma.…”

Section: March 2019mentioning

confidence: 99%

Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Yatabe

Đačić

Borczuk

et al. 2019

Journal of Thoracic Oncology

256

221

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Since the 2015 WHO classification was introduced into clinical practice, immunohistochemistry (IHC) has figured prominently in lung cancer diagnosis. In addition to distinction of small cell versus non-small cell carcinoma, patients' treatment of choice is directly linked to histologic subtypes of non-small cell carcinoma, which pertains to IHC results, particularly for poorly differentiated tumors. The use of IHC has improved diagnostic accuracy in the classification of lung carcinoma, but the interpretation of IHC results remains challenging in some instances. Also, pathologists must be aware of many interpretation pitfalls, and the use of IHC should be efficient to spare the tissue for molecular testing. The International Association for the Study of Lung Cancer Pathology Committee received questions on practical application and interpretation of IHC in lung cancer diagnosis. After discussions in several International Association for the Study of Lung Cancer Pathology Committee meetings, the issues and caveats were summarized in terms of 11 key questions covering common and important diagnostic situations in a daily clinical practice with some relevant challenging queries. The questions cover topics such as the best IHC markers for distinguishing NSCLC subtypes, differences in thyroid transcription factor 1 clones, and the utility of IHC in diagnosing uncommon subtypes of lung cancer and distinguishing primary from metastatic tumors. This article provides answers and explanations for the key questions about the use of IHC in diagnosis of lung carcinoma, representing viewpoints of experts in thoracic pathology that should assist the community in the appropriate use of IHC in diagnostic pathology.

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Section: March 2019mentioning

confidence: 99%

Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Yatabe

Đačić

Borczuk

et al. 2019

Journal of Thoracic Oncology

256

221

View full text Add to dashboard Cite

show abstract

“…Core biopsy should be encouraged for backup, especially when ROSE shows that the sample cellularity might be too low for analysis. 21 Kimbrell et al 36 addressed the issues concerning the utilization of immunocytochemistry in the sub-classification of non-small cell lung carcinomas.…”

Section: Committee IVmentioning

confidence: 99%

Utilization of ancillary studies in the cytologic diagnosis of respiratory lesions: The papanicolaou society of cytopathology consensus recommendations for respiratory cytology

Layfield

Roy‐Chowdhuri

Baloch

et al. 2016

Diagnostic Cytopathology

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The Papanicolaou Society of Cytopathology has developed a set of guidelines for respiratory cytology including indications for sputum examination, bronchial washings and brushings, CT-guided FNA and endobronchial ultrasound guided fine needle aspiration (EBUS-FNA), as well as recommendations for classification and criteria, ancillary testing and post-cytologic diagnosis management and follow-up. All recommendation documents are based on the expertise of committee members, an extensive literature review, and feedback from presentations at national and international conferences. The guideline documents selectively present the results of these discussions. The present document summarizes recommendations for ancillary testing of cytologic samples. Ancillary testing including microbiologic, immunocytochemical, flow cytometric, and molecular testing, including next-generation sequencing are discussed.

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“…6–8 Accurate subtyping depends heavily on conventional histology and cytology, sometimes supplemented with immunohistochemical (IHC) stains. The majority of ADC and SqCC cases can be diagnosed by cytomorphology alone, 9 but there remain difficult cases that defy this approach. High interobserver agreement in distinguishing small cell lung cancer from NSCLC in cytologic material is well established, 10 but less information is available on interobserver variability in subtyping NSCLC.…”

mentioning

confidence: 99%

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

Zakowski

Rekhtman²,

Auger³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context The National Cancer Care Network and the combined College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology guidelines indicate that all lung adenocarcinomas (ADCs) should be tested for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements. As the majority of patients present at a later stage, the subclassification and molecular analysis must be done on cytologic material. Objective To evaluate the accuracy and interobserver variability among cytopathologists in subtyping non–small cell lung carcinoma using cytologic preparations. Design Nine cytopathologists from different institutions submitted cases of non–small cell lung carcinoma with surgical follow-up. Cases were independently, blindly reviewed by each cytopathologist. A diagnosis of ADC or squamous cell carcinoma was rendered based on the Diff-Quik, Papanicolaou, and hematoxylin-eosin stains. The specimen types included fine-needle aspiration from lung, lymph node, and bone; touch preparations from lung core biopsies; bronchial washings; and bronchial brushes. A major disagreement was defined as a case being misclassified 3 or more times. Results Ninety-three cases (69 ADC, 24 squamous cell carcinoma) were examined. Of 818 chances (93 cases × 9 cytopathologists) to correctly identify all the cases, 753 correct diagnoses were made (92% overall accuracy). Twenty-five of 69 cases of ADC (36%) and 7 of 24 cases of squamous cell carcinoma (29%) had disagreement (P = .16). Touch preparations were more frequently misdiagnosed compared with other specimens. Diagnostic accuracy of each cytopathologist varied from 78.4% to 98.7% (mean, 91.7%). Conclusion Lung ADC can accurately be distinguished from squamous cell carcinoma by morphology in cytologic specimens with excellent interobserver concordance across multiple institutions and levels of cytology experience.

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Subclassification of Non-Small Cell Lung Cancer by Cytologic Sampling: A Logical Approach with Selective Use of Immunocytochemistry

Cited by 12 publications

References 62 publications

Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Utilization of ancillary studies in the cytologic diagnosis of respiratory lesions: The papanicolaou society of cytopathology consensus recommendations for respiratory cytology

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

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