Patrick Micke1, Johanna Sofia Margareta Mattsson1, Dijana Djureinovic1, Björn Nodin2, Karin Jirström3, Lena Tran4, Per Jönsson5, Maria Planck6, Johan Botling1, Hans Brunnström7. 1. Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. 2. Department of Clinical Sciences in Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden. 3. Department of Clinical Sciences in Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden; Department of Pathology, Regional Laboratories, Region Skåne, Lund, Sweden. 4. Department of Pathology, Regional Laboratories, Region Skåne, Lund, Sweden. 5. Department of Thoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden. 6. Department of Clinical Sciences in Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden. 7. Department of Clinical Sciences in Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden; Department of Pathology, Regional Laboratories, Region Skåne, Lund, Sweden. Electronic address: hans.brunnstrom@med.lu.se.
Abstract
INTRODUCTION: Histopathological classification of lung cancer is of central importance in the diagnostic routine, and it guides therapy in most patients. The fourth edition of the World Health Organization (WHO) Classification of Lung Tumours was recently published and includes changes to the diagnostic procedure for non-small cell carcinomas (NSCCs), with more emphasis on immunohistochemical (IHC) staining. METHODS: A total of 656 unselective cases of resected pulmonary NSCC were diagnosed according to the 2004 WHO classification. After IHC staining with cytokeratin 5, p40, p63, thyroid transcription factor 1 (clones 8G7G3/1 and SPT24), and napsin A, the diagnoses were revised in accordance with the new fourth edition of the WHO classification. RESULTS: Reclassification led to a new histological annotation in 36 of the 656 cases (5%). Most notable was the decrease in cases previously classified as large cell carcinomas (56 versus 12 cases). This was partially due to the exclusion of 21 neuroendocrine tumors from this group, with 20 cases ascribed to the adenocarcinoma group on the basis of IHC markers. Only seven cases of adenocarcinoma or squamous cell carcinoma were reclassified after the addition of IHC staining. There was a substantial overlap in staining properties between different markers of squamous and adenocarcinomatous differentiation, respectively, but in 17 to 31 cases (3%-5%), the diagnosis depended on the choice of markers. CONCLUSIONS: The fourth edition of the WHO Classification of Lung Tumours leads to changes in histological type in 5% of resected NSCCs. The incorporation of IHC staining into NSCC diagnostics demands awareness that the choice of ancillary stains has an effect on diagnosis.
INTRODUCTION: Histopathological classification of lung cancer is of central importance in the diagnostic routine, and it guides therapy in most patients. The fourth edition of the World Health Organization (WHO) Classification of Lung Tumours was recently published and includes changes to the diagnostic procedure for non-small cell carcinomas (NSCCs), with more emphasis on immunohistochemical (IHC) staining. METHODS: A total of 656 unselective cases of resected pulmonary NSCC were diagnosed according to the 2004 WHO classification. After IHC staining with cytokeratin 5, p40, p63, thyroid transcription factor 1 (clones 8G7G3/1 and SPT24), and napsin A, the diagnoses were revised in accordance with the new fourth edition of the WHO classification. RESULTS: Reclassification led to a new histological annotation in 36 of the 656 cases (5%). Most notable was the decrease in cases previously classified as large cell carcinomas (56 versus 12 cases). This was partially due to the exclusion of 21 neuroendocrine tumors from this group, with 20 cases ascribed to the adenocarcinoma group on the basis of IHC markers. Only seven cases of adenocarcinoma or squamous cell carcinoma were reclassified after the addition of IHC staining. There was a substantial overlap in staining properties between different markers of squamous and adenocarcinomatous differentiation, respectively, but in 17 to 31 cases (3%-5%), the diagnosis depended on the choice of markers. CONCLUSIONS: The fourth edition of the WHO Classification of Lung Tumours leads to changes in histological type in 5% of resected NSCCs. The incorporation of IHC staining into NSCC diagnostics demands awareness that the choice of ancillary stains has an effect on diagnosis.
Authors: Hans Brunnström; Anna Johansson; Sofia Westbom-Fremer; Max Backman; Dijana Djureinovic; Annika Patthey; Martin Isaksson-Mettävainio; Miklos Gulyas; Patrick Micke Journal: Mod Pathol Date: 2017-06-30 Impact factor: 7.842
Authors: Marianna Grinberg; Dijana Djureinovic; Hans Rr Brunnström; Johanna Sm Mattsson; Karolina Edlund; Jan G Hengstler; Linnea La Fleur; Simon Ekman; Hirsh Koyi; Eva Branden; Elisabeth Ståhle; Karin Jirström; Derek K Tracy; Fredrik Pontén; Johan Botling; Jörg Rahnenführer; Patrick Micke Journal: Mod Pathol Date: 2017-03-10 Impact factor: 7.842
Authors: Johanna S M Mattsson; Hans Brunnström; Verena Jabs; Karolina Edlund; Karin Jirström; Stephanie Mindus; Linnéa la Fleur; Fredrik Pontén; Mats G Karlsson; Christina Karlsson; Hirsh Koyi; Eva Brandén; Johan Botling; Gisela Helenius; Patrick Micke; Maria A Svensson Journal: BMC Cancer Date: 2016-08-05 Impact factor: 4.430