Non-small cell carcinoma-not otherwise specified on cytology specimens in patients with solitary pulmonary lesion: Primary lung cancer or metastatic cancer?

Context: Subtyping of solitary pulmonary lesion (SPL) in small amount of cytology specimen using a limited panel of immunohistochemistry (IHC) markers is very important to the correct choice of treatment. This study was performed to categorize non-small cell carcinoma-not otherwise specified (NSCC-N...

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Bibliographic Details
Published in:Journal of cytology 2021-01, Vol.38 (1), p.8-13
Main Authors: Lee, Hyoun, Ha, Seung, Roh, Mee
Format: Article
Language:English
Subjects:
Breast
Cancer
Carcinoma
Care and treatment
CDX2 protein
Cellular biology
Cytology
Diagnosis
Duodenum
Gallbladder
Immunohistochemistry
Lung cancer
Lung carcinoma
Malignancy
Metastases
Metastasis
metastatic cancer
non-small cell cancer
non-small cell lung cancer
Non-small cell lung carcinoma
Original
Pancreas
Patients
Prostate
Pulmonary lesions
Small cell lung carcinoma
solitary pulmonary lesion
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Summary:Context: Subtyping of solitary pulmonary lesion (SPL) in small amount of cytology specimen using a limited panel of immunohistochemistry (IHC) markers is very important to the correct choice of treatment. This study was performed to categorize non-small cell carcinoma-not otherwise specified (NSCC-NOS) on cytology in patients with SPL, especially with regard to the incidence of metastatic cancer. Materials and Methods: We reviewed 91 cases, in which a precise morphology-based, lineage-specific IHC-aided subtyping was not possible, that qualified as NSCC-NOS on cytology. A stepwise clinical approach and IHC of organ-specific markers was performed on each cell block (CB) to exclude metastasis from extrapulmonary malignancies. Results: Of the 91 evaluated cases, 65 (71.4%) were diagnosed as non-small cell lung carcinoma (NSCLC)-NOS, 24 (26.4%) were metastatic cancer, and the remaining 2 (2.2%) had undetermined diagnoses. The most frequent primary tumor site was the colorectum (41.7%), followed by breast (20.8%), kidney (8.3%), and then stomach, duodenum, liver, pancreas, gallbladder, prostate, and skin (4.2% each, 1 of 24). Moreover, we found that 7 of the 24 patients with metastatic cancer had a history of extrapulmonary malignancy that was unknown at the time of cytology-based diagnosis. Conclusions: These results underscored the need for accurate and stepwise clinical correlation to rule out the possibility of pulmonary metastasis from other sites and appropriate but judicious IHC (i.e., CDX2) on CB for SPL to increase refinement of the cytology diagnosis of NSCC-NOS.
ISSN:0970-9371
0974-5165
DOI:10.4103/JOC.JOC_94_20