Significance of Immunohistochemistry Testing in the Diagnosis and Subtyping of Lung Carcinomas- A Retrospective Study from a Tertiary Care Centre in Southern Rajasthan

P. Agrawal, K. Gupta, Pawan Nikhra, Mala Jain, M. Pandey, A. Pandey
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Abstract

Introduction: In the present era, the classification of lung carcinoma is not confined to Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC). Precise subtyping of lung carcinoma has a direct impact on patient management and prognosis. Further molecular study helps in identifying adenocarcinoma receptors, such as Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK), which are useful in targeted therapy. Aim: To assess the role of Immunohistochemistry (IHC) in accurate diagnosis and subtyping of lung carcinoma and to analyse the prevalence of EGFR mutations and ALK rearrangement in lung adenocarcinoma. Materials and Methods: A retrospective hospital-based, observational study was conducted at the Department of Pathology of American International Institute of Medical Sciences, Udaipur, Rajasthan from January 2020 to August 2021. Total of 105 cases of guided core needle biopsies from lung and bronchoscopic biopsies were included. IHC markers were applied based on histopathological diagnosis from a panel of p63, Cytokeratin 7 (CK7), AE1/AE3, Thyroid Transcription Factor (TTF1), Napsin A, p40, synaptophysin, chromogranin, CD56 and Ki67. Adenocarcinoma cases were further analysed for EGFR mutations and ALK rearrangements. Data was tabulated and analysed statistically using Microsoft Excel to determine the percentage frequency distribution of cases. Results: Among 105, there were 88 males and 17 females and the mean age of the population was 60.57 years. The most prevalent subtype of lung malignancy was squamous cell carcinoma (44.7%) followed by adenocarcinoma (29.5%). The diagnostic accuracy of squamous cell carcinomas and adenocarcinomas on morphology was 93.1% and 84.6%, respectively and for small cell carcinoma it was 100%. Amongst 28 cases of adenocarcinoma, EGFR mutation was found in 46.42% cases whereas ALK mutation was found only in 21.42% cases. Conclusion: The study highlights the importance of IHC, and a substantial prevalence of EGFR mutations was found in patients with lung carcinoma.
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免疫组织化学检测在肺癌诊断和分型中的意义——来自拉贾斯坦邦南部三级保健中心的回顾性研究
在当今时代,肺癌的分类并不局限于小细胞肺癌(SCLC)和非小细胞肺癌(NSCLC)。肺癌的精确分型直接影响患者的治疗和预后。进一步的分子研究有助于确定腺癌受体,如表皮生长因子受体(EGFR)和间变性淋巴瘤激酶(ALK),这对靶向治疗是有用的。目的:探讨免疫组化(IHC)在肺癌准确诊断和分型中的作用,分析肺腺癌中EGFR突变和ALK重排的发生率。材料和方法:2020年1月至2021年8月,在拉贾斯坦邦乌代普尔美国国际医学研究所病理学系进行了一项基于医院的回顾性观察性研究。共纳入105例肺穿刺活检及支气管镜活检。基于组织病理学诊断,采用免疫组化标记,检测p63、细胞角蛋白7 (CK7)、AE1/AE3、甲状腺转录因子(TTF1)、Napsin a、p40、synaptophysin、chromogranin、CD56和Ki67。进一步分析腺癌病例的EGFR突变和ALK重排。将数据制成表格并使用Microsoft Excel进行统计分析,以确定病例的百分比频率分布。结果:105例患者中男性88例,女性17例,平均年龄60.57岁。肺恶性肿瘤最常见的亚型是鳞状细胞癌(44.7%),其次是腺癌(29.5%)。鳞状细胞癌和腺癌在形态学上的诊断准确率分别为93.1%和84.6%,小细胞癌的诊断准确率为100%。28例腺癌中,EGFR突变占46.42%,ALK突变仅占21.42%。结论:该研究强调了免疫组化的重要性,并且发现肺癌患者中存在大量EGFR突变。
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审稿时长
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