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. 2022 Dec 26;14(12):e32956.
doi: 10.7759/cureus.32956. eCollection 2022 Dec.

Accuracy of Classifying Lung Carcinoma Using Immunohistochemical Markers on Limited Biopsy Material: A Two-Center Study

Amber Hassan  1   2 , Shadi Alahmadi  3 , Omer Waqas  4 , Humaira Waseem  5 , Amer Shafie Abdelrahman  6 , Majid Almansouri  7 , Nasser Mulla  8 , Yousef Katib  9 , Salwa I Bakhsh  10 , Mohammed Basheikh  11 , Samy A Abusikkien  12   13 , Mohamed Matoog Karami  14 , Marwan Al-Hajeili  15 , Samah S Elbasateeny  16   17
Affiliations

Accuracy of Classifying Lung Carcinoma Using Immunohistochemical Markers on Limited Biopsy Material: A Two-Center Study

Amber Hassan et al. Cureus. .

Abstract

Introduction Accurate classification of lung cancer into primary and metastatic carcinomas is critical for treatment approaches. Immunohistochemistry (IHC) has always been pivotal in unveiling the diverse cell differentiation lineages present in lung cancer by using specific biomarkers such as TTF1 and p63/p40, which closely reflect the relationship between genotype and phenotype.. Methods A retrospective cross-sectional study was conducted to evaluate 57 Tru-Cut biopsies over two years, from 2020-2022. Tumour morphology was evaluated, and IHC for TTF-1, Napsin A, CK-7, P-63, P-40, and CD-56 was performed in two steps. Results Of the lung cancer cases, 58.5% were adenocarcinoma (ADC), 24.5% were squamous cell carcinoma (SCC), 9.4% were small cell carcinoma, and 7.5% were poorly differentiated carcinoma. TTF1 stain had sensitivity and specificity of 78.9% and 50% in 33 cases of ADC, respectively, while CK7 and Napsin A had 100% sensitivity. P63 stain had 77% sensitivity and 50% specificity in 15 cases of SCC, while P-40 had 100% sensitivity. The CD56 stain was 100% sensitive in five cases of small cell carcinoma. Conclusion IHC staining on small lung biopsies allows accurate sub-classification of poorly differentiated lung cancers; however, there is still significant variability. Surgical resection specimens can be further classified due to architectural features that biopsies lack. Morphological findings would be beneficial in the development of an algorithm for sub-classifying lung carcinoma using a variety of markers.

Keywords: adenocarcinoma; immunohistochemistry; lc; sensitivity; small cell carcinoma; specificity; squamous cell carcinoma; trucut biopsy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Photograph of IHC panel: (A) IHC of TTF1 shows the nuclear positivity in tumour cells; (b) CK-7 shows cytoplasmic staining in tumour cells; (C) P40 shows nuclear and cytoplasmic staining; (D) Napsin-A shows granular cytoplasmic and nuclear staining in tumour cells
IHC: immunohistochemistry
See this image and copyright information in PMC

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