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Role of Immunohistochemistry in the Detection of Targetable Mutations

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Diagnosing Non-small Cell Carcinoma in Small Biopsy and Cytology

Abstract

Testing for EGFR gene mutations and ALK rearrangements has entered everyday clinical practice for the management of patients with pulmonary adenocarcinoma. With the development of more sensitive molecular techniques to detect specific mutations, small biopsy and cytologic specimens are being used more frequently for diagnostic work-up and molecular characterization of lung carcinoma. Molecular testing, however, is not widely offered due to cost constraints and technical complexity, including highly skilled and trained personnel to perform and interpret the results. Despite suitability of small biopsy and cytologic material for molecular tests, samples are periodically inadequate for molecular tests. Therefore, immunohistochemical stains offer the potential to detect mutant proteins as an alternative or adjunct to molecular techniques thereby expanding availability of molecular characterization of tumors.

Most laboratories have the infrastructure to perform immunohistochemical tests, and pathologists are familiar with interpretation and reporting of the tests. In addition, the results are typically available within 24 h in most laboratories as opposed to the more time-consuming molecular tests. More importantly, mutation-specific antibodies can play a significant role when diagnostic material is unsatisfactory for molecular testing due to low tumor content or decalcification, as in cases of bone biopsies. A positive immunohistochemical result could avoid re-biopsy of the patient for procurement of additional tissue for mutation analysis.

This chapter discusses the clinical utility and efficacy of immunohistochemical markers for detecting specific molecular alterations in small biopsy material.

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  1. Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA

    Andre Luis Moreira M.D., Ph.D.

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  1. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Andre Luis Moreira

  2. Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, USA

    Anjali Saqi

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Moreira, A.L. (2015). Role of Immunohistochemistry in the Detection of Targetable Mutations. In: Moreira, A., Saqi, A. (eds) Diagnosing Non-small Cell Carcinoma in Small Biopsy and Cytology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1607-8_7

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