Abstract
Introduction: Majority of lung cancer presents at an advanced unresectable stage, emphasizing the diagnosis on cytological specimens like EBUS-TBNA. This study was aimed to subtype lung carcinomas on EBUS-TBNA specimens on smears and cell blocks (CB) and to assess the utility of limited panel ICC towards this subtyping. Materials and Methods: This is both retrospective and prospective study done on total of 142 cases for two and half years. The samples from either lung or mediastinal lymph nodes diagnosed as lung carcinoma on cytomorphology in correlation with clinico – radiological features were included. Extrapulmonary metastatic tumors, lymphomas and malignancies other than carcinomas were excluded. The cytologic material (EBUS-TBNA smears and CB) was obtained by EBUS TBNA procedure done on lung lesions and/or mediastinal lymph nodes and stained with required stains. All cases were first classified as small cell carcinoma (SCC) and non small cell carcinoma (NSCC) on cytomorphology as per 2004 WHO classification. NSCC was then further subtyped. ICC with TTF1/p63 antibodies was applied on NSCC and synaptophysin on SCC/neuroendocrine tumors. Napsin A was applied on p63/TTF1 negative cases. The results were expressed in frequencies and percentages. Result: On cytomorphology alone, 25 of 142 cases (17.6%) were classified as SCC and 117 cases (82.4%) as NSCC. NSCC was further subtyped on cytomorphology (smears+CB) into definitive (squamous cell carcinoma [SqCC]/adenocarcinoma [ADC]) v/s favouring (favouring SqCC/ ADC/ adenosquamous carcinoma) v/s not otherwise specified (NOS) in 41 (35.1%) v/s 33(28.2%) v/s 43(36.7%) cases respectively. Immunostains TTF1/ p63 and napsin A applied on possible 86 NSCC cases reduced NOS to 9.3 %. Synaptophysin confirmed all 20 cases of SCC and 1 large cell neuroendocrine carcinoma (LCNC). Overall in 142 cases, limited panel ICC reduced NSCC-NOS to 11.9%. Conclusion: Subtyping of lung carcinoma on EBUS- TBNA samples is feasible. Preparat
Highlights
Majority of lung cancer presents at an advanced unresectable stage, emphasizing the diagnosis on cytological specimens like EBUS-TBNA
Bakshi and Verma / IP Archives of Cytology and Histopathology Research 2019;4(4):[315–323] bevacizumab require distinction of non small cell carcinoma (NSCC) into ADC and SqCC. 4,5 Subtyping of lung carcinoma on cytomorphology is challenging due to overlapping features or poorly differentiated nature of tumor. 6,7 ICC as an adjunctive tool to cytomorphology is available in some studies in literature. 8,9 data using this on EBUS-TBNA material is limited with no study reported from India so far. 10–13 As cytology material may be conserved for molecular studies, a limited but optimal use of ICC needs to be determined. 12
The aim of this study was to know the efficacy of cytomorphology in subclassification of lung carcinomas on EBUS-TBNA samples & to assess the value of addition of limited panel ICC as an adjunct to cytomorphology in this subtyping
Summary
Majority of lung cancer presents at an advanced unresectable stage, emphasizing the diagnosis on cytological specimens like EBUS-TBNA. This study was aimed to subtype lung carcinomas on EBUS-TBNA specimens on smears and cell blocks (CB) and to assess the utility of limited panel ICC towards this subtyping. A limited panel ICC comprising p63, TTF1 and synaptophysin can classify in majority of cases with napsin A useful as secondary antibody in p63, TTF1 negative cases. IntroductionThe aim of this study was to know the efficacy of cytomorphology (smears and CB) in subclassification of lung carcinomas on E BUS-TBNA samples & to assess the value of addition of limited panel ICC as an adjunct to cytomorphology in this subtyping. The aim of this study was to know the efficacy of cytomorphology (smears and CB) in subclassification of lung carcinomas on EBUS-TBNA samples & to assess the value of addition of limited panel ICC as an adjunct to cytomorphology in this subtyping Bakshi and Verma / IP Archives of Cytology and Histopathology Research 2019;4(4):[315–323] bevacizumab require distinction of NSCC into ADC and SqCC. 4,5 Subtyping of lung carcinoma on cytomorphology is challenging due to overlapping features or poorly differentiated nature of tumor. 6,7 ICC as an adjunctive tool to cytomorphology is available in some studies in literature. 8,9 data using this on EBUS-TBNA material is limited with no study reported from India so far. 10–13 As cytology material may be conserved for molecular studies, a limited but optimal use of ICC needs to be determined. 12
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