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Sung YE, Kim M. Revisiting ALK (D5F3) immunohistochemistry: Insights into focal staining and neuroendocrine differentiation. Thorac Cancer 2024. [PMID: 39257160 DOI: 10.1111/1759-7714.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Screening for anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) is crucial for identifying patients eligible for targeted therapy. The FDA-approved ALK (D5F3) immunohistochemistry (IHC) assay, used with the OptiView Amplification Kit, demonstrates excellent sensitivity and specificity in detecting these patients. However, the clinical significance of resulting focal positivity remains unclear, and ALK (D5F3) expression unrelated to ALK fusion is observed in some cases of neuroendocrine differentiation. This study aims to validate these findings with molecular testing and contribute to the accurate interpretation of ALK (D5F3) IHC results. METHODS A total of 1619 patients diagnosed with NSCLC and neuroendocrine carcinoma were evaluated using ALK (D5F3) IHC. For cases with strong but focal expression and those with diffuse strong positivity in neuroendocrine differentiation, ALK fluorescence in situ hybridization (FISH) and/or next-generation sequencing (NGS) tests were performed. RESULTS Seven out of 1109 adenocarcinomas (0.6%) and six out of 289 squamous cell carcinomas (2.1%) exhibited strong focal ALK (D5F3) expression. Nine out of 209 neuroendocrine carcinomas (4.3%) showed homogeneously strong ALK (D5F3) expression. All these cases, including adenocarcinoma with neuroendocrine differentiation and combined small cell carcinoma, were negative for ALK fusions by FISH and/or NGS. CONCLUSION This study demonstrates that strong but focal ALK (D5F3) immunostaining and strong expression in neuroendocrine differentiation may not indicate ALK fusion. By considering these findings, we can improve the accuracy of patient selection for targeted therapy by minimizing false-positive interpretations of ALK (D5F3) staining.
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Affiliation(s)
- Yeoun Eun Sung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Meejeong Kim
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Ramani NS, Patel KP, Routbort MJ, Alvarez H, Broaddus R, Chen H, Rashid A, Lazar A, San Lucas FA, Yao H, Manekia J, Dang H, Barkoh BA, Medeiros LJ, Luthra R, Roy-Chowdhuri S. Factors Impacting Clinically Relevant RNA Fusion Assays Using Next-Generation Sequencing. Arch Pathol Lab Med 2021; 145:1405-1412. [PMID: 33493304 DOI: 10.5858/arpa.2020-0415-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— RNA-based next-generation sequencing (NGS) assays are being used with increasing frequency for comprehensive molecular profiling of solid tumors. OBJECTIVE.— To evaluate factors that might impact clinical assay performance. DESIGN.— A 4-month retrospective review of cases analyzed by a targeted RNA-based NGS assay to detect fusions was performed. RNA extraction was performed from formalin-fixed, paraffin-embedded tissue sections and/or cytology smears of 767 cases, including 493 in-house and 274 outside referral cases. The types of samples included 422 core needle biopsy specimens (55%), 268 resection specimens (35%), and 77 cytology samples (10%). RESULTS.— Successful NGS fusion testing was achieved in 697 specimens (90.9%) and correlated positively with RNA yield (P < .001) and negatively with specimen necrosis (P = .002), decalcification (P < .001), and paraffin block age of more than 2 years (P = .001). Of the 697 cases that were successfully sequenced, 50 (7.2%) had clinically relevant fusions. The testing success rates and fusion detection rates were similar between core needle biopsy and cytology samples. In contrast, RNA fusion testing was often less successful using resection specimens (P = .007). Testing success was independent of the tumor percentage in the specimen, given that at least 20% tumor cellularity was present. CONCLUSIONS.— The success of RNA-based NGS testing is multifactorial and is influenced by RNA quality and quantity. Identification of preanalytical factors affecting RNA quality and yield can improve NGS testing success rates.
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Affiliation(s)
- Nisha S Ramani
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
| | - Keyur P Patel
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Mark J Routbort
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Hector Alvarez
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Russell Broaddus
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
| | - Hui Chen
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
| | - Asif Rashid
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
| | - Alex Lazar
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
| | - Francis A San Lucas
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Hui Yao
- and Bioinformatics and Computational Biology (Yao), The University of Texas MD Anderson Cancer Center, Houston. Broaddus is currently with the Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Jawad Manekia
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Hyvan Dang
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Bedia A Barkoh
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - L Jeffrey Medeiros
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Rajyalakshmi Luthra
- Hematopathology (Patel, Routbort, Alvarez, San Lucas, Manekia, Dang, Barkoh, Medeiros, Luthra)
| | - Sinchita Roy-Chowdhuri
- From the Departments of Pathology (Ramani, Broaddus, Chen, Rashid, Lazar, Roy-Chowdhuri)
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Biomarkers in Non-Small Cell Lung Cancers: Indian Consensus Guidelines for Molecular Testing. Adv Ther 2019; 36:766-785. [PMID: 30864106 DOI: 10.1007/s12325-019-00903-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 12/17/2022]
Abstract
Novel molecular targets and promising targeted therapies have reshaped diagnostics in patients with advanced non-small cell lung cancer (NSCLC). Despite this progress, the implementation of molecular screening to identify predictive biomarkers in Indian clinical and pathology settings has been challenging due to operational and logistical constraints. This consensus guideline brings together medical oncologists, molecular pathologists and pathologists from India to provide a quick and competent reference for biomarker testing in NSCLC. The guideline summarizes the importance of targetable mutations in NSCLC such as epidermal growth factor receptor (EGFR), rearrangements in anaplastic lymphoma kinase and receptor tyrosine kinase encoded by ROS-1 gene, overexpression of programmed cell death ligand-1 and resistant EGFR mutations. It reaffirms recommendations from international working groups, discusses vulnerable pre-analytical procedures and provides a balanced review on the pros and cons of different diagnostic tests (immunohistochemistry, fluorescence in situ hybridization, polymerase chain reaction-based testing and next-generation sequencing). The document also provides an algorithm to aid diagnostic decision-making and a checklist to assess the quality of testing laboratories that will help the medical oncologists make an informed choice. Overall, these recommendations are based on evidence and clinical experience and will aid policymakers, oncologists, health care practitioners and pathologists who strive to implement molecular strategies and make informed decisions for improved care in NSCLC in India.Funding: AstraZeneca Pharma India Limited.
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Uruga H, Mino-Kenudson M. ALK (D5F3) CDx: an immunohistochemistry assay to identify ALK-positive NSCLC patients. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2018; 11:147-155. [PMID: 30271189 PMCID: PMC6147206 DOI: 10.2147/pgpm.s156672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Screening for anaplastic lymphoma kinase (ALK) rearrangements is a very important process in treatment decision making for advanced non-small-cell lung cancer (NSCLC). Although fluorescent in situ hybridization (FISH) is considered the universally accepted reference standard, it is associated with technical difficulties and high costs that have made global implementation of this assay challenging. Conversely, ALK immunohistochemistry has shown high sensitivity and specificity compared to FISH and other molecular assays and is more cost-effective. In fact, the ALK (D5F3) CDx immunohistochemistry assay was approved by the US Food and Drug Administration as a standalone test for ALK rearrangements in lung cancer in 2015. In this review, we will discuss the overview of ALK rearrangements in NSCLC, various testing methods for ALK rearrangements, and the details of immunohistochemistry for ALK, in particular one with the ALK antibody clone D5F3.
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Affiliation(s)
- Hironori Uruga
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA,
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