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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(04): 535-542
DOI: 10.4103/ijmpo.ijmpo_51_19
Original Article

Validation of Superiority of p40 over p63 in Differentiating Squamous Cell Carcinoma and Adenocarcinoma Lung

Vamshi Thamtam
1   Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Shantveer Uppin
1   Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Monalisa Hui
1   Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
N Kumar
2   Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
K Bhaskar
2   Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Stalin Bala
3   Department of Medical oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
G Sadashivudu
3   Department of Medical oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
G Paramjyothi
2   Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Context

In this era of targeted therapy, it is important to distinguish the various subtypes of nonsmall cell lung carcinoma (NSCC). Diagnosis based on morphology alone is challenging in poorly differentiated carcinomas and core biopsies. Immunohistochemistry (IHC) helps in specifying the lineage for the subtype of NSCC. Till date, p63 is the most frequently used and sensitive marker for squamous cell carcinoma (SQCC). However, it is not specific and stains a subset of adenocarcinoma (ADC). Thus, a more reliable and specific marker is required for the diagnosis of SQCC.

Objective

The objective of the study was to validate the diagnostic utility of p40 over p63 in differentiating pulmonary SQCC from ADC and NSCC-not otherwise specified (NOS).

Materials and Methods

A total of 123 cases of NSCC were initially reviewed and subtyped blinded to the results of IHC. This was followed by a review of IHC slides which included p63, p40, thyroid transcription factor 1, Napsin-A, cytokeratin (CK) 5/6, and CK7.

Results

There were 64 ADC, 19 SQCC, and 40 NSCC-NOS. IHC helped to confirm the morphological diagnosis in 62/64 ADCs and19/19 SQCCs. IHC classified the cases of NSCC-NOS into NSCC favoring ADC – 12 cases, NSCC favoring SQCC – 10 cases, and NSCC favoring AD-SQCC – 4 cases. Both p63 and p40 showed near equal sensitivity for SQCC (100% and 97%, respectively), whereas p63 showed far lower specificity when compared to p40 (51.3% vs. 100%).

Conclusion

The present study confirms and validates that p40 is equally sensitive but highly specific than p63 in detecting SQCC. Hence, we recommend the routine use of p40 instead of p63 for the definite categorization of NSCC of the lung.

Keywords

Immunohistochemistry - lung - nonsmall cell carcinoma - p40 - p63


Publication History

Received: 26 February 2019

Accepted: 29 June 2020

Article published online:
17 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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