Clinical Radiological and Immunohistochemical Profile of Non Small Cell Lung Carcinoma

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DOI: 10.21522/TIJMD.2013.04.01.Art001

Authors : Suhail Neliyathodi, Asha Krishnan

Abstract:

Objectives: To evaluate clinical, radiological and immunohistochemichal profile of non small cell lung carcinoma (NSCLC). Settings and study design: A cross sectional study conducted among all diagnosed cases of primary lung malignancy in the Department of Respiratory Medicine MES Medical College Perinthalmanna . Materials and methods: The 41 biopsy proven cases of NSCLC was studied during a period of 1 ½ years, A detailed history, clinical evaluation and the relevant investigation is done, small biopsy specimens are collected, a histopathological evaluation was done and the markers Thyroid Transcription Factor-1(TTF1), Epidermal Growth Factor Receptor (EGFR) and p-63 status was determine by immunohistochemistry(IHC) Results: Of the 41 cases, Squamous cell carcinoma was the predominant histological type with a male predominance and a peak incidence in 61-70 yrs of age. (58.53%) cases showed EGFR positivity. TTF1 positivity was predominant with adenocarcinoma and p63 positivity with squamous cell carcinoma. Smoking status and EGFR in adenocarcinoma shown that there is a significant number of EGFR positivity associated with non-smokers and all were females. The study could attain a 85.71% sensitivity and 92.59% specificity for ttf1 in adenocarcinoma and 88% sensitivity and 100% specificity for p63 in squamous cell carcinoma. Conclusion: IHC can be used as a rapid and effective tool for diagnosing the histologic type of NSCLC because of its high sensitivity and specificity. In adenocarcinoma, there is a significant number of EGFR positivity associated with non-smokers females.

References:

[1.]   American Cancer Society. Cancer Facts and Figures 2011. Available at: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2011

[2.]   Antonio Marchetti, Carla Martella, Lara Felicioni, Fabiobarassi, Simona Salvatore, Antonio Chella et al:EGFR Mutation In Non – Small Cell Lung Cancer: Analysis of a Large Series of Cases And Development of a Rapid and Sensitive Method for Diagnostic Screening With Potential Implication on Pharmacologic Treatment. Journal of Clinical Oncology 2005;23(4):857-865.

[3.]   Behera D, Epidemiology of lung cancer – Global and Indian perspective Review article JIACM 2012; 13(2): 131-7

[4.]   Binukumar Bhaskarapillai, Saina Sunil Kumar, Satheesan Balasubramanian lung cancer in Malabar Cancer Centre in Kerala- A Descriptive Analysis. Asian Pacific Journal of Cancer Prevention, Vol 13, 2012 .

[5.]   Choong NW, Salgia R, Vokes EE. Key signaling pathways and targets in lung cancer therapy. Clin Lung Cancer 2007; 8 Suppl 2: S52-S60

[6.]   Dhananjay Saranath and Aparna Khanna, Current Status Of Cancer Burden: Global And Indian Scenario. Biomedical Research Journal, 2014;1(1):1-5

[7.]   Dunagan D, Chin R Jr, McCain T, Case L, Harkness B, Oaks T, et al. Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer. Chest 2001; 119(2): 333-339

[8.]   Edwards SL, Roberts C, McKean ME, et al. Preoperative histological classification of primary lung cancer: accuracy of diagnosis and use of the non-small cell category. J Clin Pathol 2000;53:537–540.

[9.]   GLOBCAN facts and figures 2012

[10.]   Hiroshi Haneda, Hidefumi Sasaki, Osamu Kawano, et al. A Correlation Between EGFR Gene Mutation Status And Bronchoalveolar Carcinoma Features In Japanese Patients With Adenocarcinoma; Jpn J Clin Oncol2006;36(2)69-75

[11.]   IARC. Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 83 Tobacco Smoke and Involuntary Smoking. 2004.

[12.]   Kerr K. M, Bubendorf L, Edelman M. J, Marchetti A, Mok5 T, Novello S, O’Byrne K, Stahel, S. Peters R, Felip E & Panel Members. Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer ;Annals of Oncology 25: 1681–1690, 2014.

[13.]   Murrey and nadal’s trxt book of respiratory medicine. Fifth edition.

[14.]   NCCN Guidelines for Patients. Lung Cancer Screening, Version 1.2014

[15.]   Ordóñez NG: Value of thyroid transcription factor-1, E-c adherin, BG8, WT1, and CD44S immunostaining in distinguishing epithelial pleural mesothelioma from pulmonary and nonpulmonary adenocarcinoma. Am J Surg Pathol 24:598-606, 2000

[16.]   Ou SH, Zell JA. Carcinoma NOS is a common histologic diagnosis and is increasing in proportion among non-small cell lung cancer histologies. J Thorac Oncol 2009;4:1202–1211

[17.]   Pham DK, Kris MG, Riely GJ. Use of cigarette-smoking history to estimate the likelihood of mutations in epidermal growth factor receptor gene exons 19 and 21 in lung adenocarcinomas. J Clin Oncol 2006; 24: 1700–1704.

[18.]   Rossi G, Pelosi G, Graziano P, Barbareschi M, Papotti M. A reevaluation of the clinical significance of histological subtyping of non–small-cell lung carcinoma: diagnostic algorithms in the era of personalized treatments. Int J Surg Pathol 2009;17:206–218

[19.]   Sequist LV, Joshi VA, Janne PA, Muzikansky A, Fidias P, Meyerson M, Haber DA, Kucherlapati R, Johnson BE, Lynch TJ: Response to treatment and survival of patients with non-small cell lung cancer undergoing somatic EGFR mutation testing. Oncologist 2007, 12:90–98

[20.]   Shanmugapriya Shankar, Vijayalakshmi Thanasekaran1, Dhanasekar1 T, Prathiba Duvooru, Clinicopathological and immunohistochemical profile of non–small cell lung carcinoma in a tertiary care medical centre in South India. Lung India • Vol 31 • Issue 1 • Jan - Mar 2014

[21.]   Sheikh HA, Fuhrer K, Cieply K, Yousem S. p63 expression in assessment of bronchioloalveolar proliferations of the lung. Mod Pathol 2004;17:1134–40.

[22.]   Sheppard MN: Specific markers for pulmonary tumours. Histopathology 36:273-276, 2000

[23.]   Stenhouse G, Fyfe N, King G, Chapman A, Kerr K M. Thyroid transcription factor 1 in Pulmonary adenocarcinoma; J Clini Pathol 2004; 57:383-387.

[24.]   Swerdlow AJ, Peto R, Doll R. Epidemiology of cancer. In: Oxford Textbook of Medicine. Oxford, UK: Oxford University Press; 2010:299–332.

[25.]   Travis WD, Rekhtman N, Riley GJ, et al. Pathologic diagnosis of advanced lung cancer based on small biopsies and cytology: a paradigm shift. J Thorac Oncol 2010;5:411–414.

[26.]   Tsao AS, Tang XM, Sabloff B. Clinicopathologic characteristics of the EGFR gene mutation in non-small cell lung cancer. J Thorac Oncol 2006; 1: 231–239.

[27.]   Valsamo K. Anagnostou, Konstantinos N. Syrigos, Gerold Bepler, Robert J. Homer, and David L. Rimm. Thyroid Transcription Factor 1 Is an Independent Prognostic Factor for Patients With Stage I Lung Adenocarcinoma; JOURNAL OF CLINICAL ONCOLOGY:VOLUME 27:NUMBER 2:JANUARY 10 2009.

[28.]   Zhou C, Wu YL, Chen G. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label randomized phase 3 study. Lancet Oncol 2011; 12: 735–7429