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Lack of supportive evidence for the use of immunohistochemical staining to identify occult regional lymph node metastases in primary lung cancer.

Jönsson, Per LU ; Johansson, Leif LU ; Planck, Maria LU and Brunnström, Hans LU (2014) In Virchows Archiv: an international journal of pathology 464(4). p.429-434
Abstract
Immunohistochemical (IHC) staining for the identification of nodal occult metastases (OM), not detected by routine histological examination, has been proposed for improved staging, prognostication and decision of adjuvant treatment in surgically treated primary lung cancer. In a prospective study, we analysed 178 cases of primary lung cancer stage I-III (N0-N1) for OM by immunostaining lymph node tissue using a broad-spectrum anti-cytokeratin antibody. OM were found in 7 (4 %) of the 178 cases. Using Kaplan-Meier analysis, overall survival was not significantly different between cases with stage I and cases upstaged to stage II because of OM (n = 3), or between cases with stage II and cases upstaged to stage III (n = 4). Likewise, the... (More)
Immunohistochemical (IHC) staining for the identification of nodal occult metastases (OM), not detected by routine histological examination, has been proposed for improved staging, prognostication and decision of adjuvant treatment in surgically treated primary lung cancer. In a prospective study, we analysed 178 cases of primary lung cancer stage I-III (N0-N1) for OM by immunostaining lymph node tissue using a broad-spectrum anti-cytokeratin antibody. OM were found in 7 (4 %) of the 178 cases. Using Kaplan-Meier analysis, overall survival was not significantly different between cases with stage I and cases upstaged to stage II because of OM (n = 3), or between cases with stage II and cases upstaged to stage III (n = 4). Likewise, the presence of OM was not significantly correlated with overall survival in univariable or multivariable Cox proportional hazards regression models, also when disregarding OM <0.2 mm in size. Given the low frequency of OM and lack of significant impact on survival in our study, the justification for including IHC staining of lymph nodes in lung cancer in clinical practise does not appear convincing. Moreover, we report several potential pitfalls in the use of broad-spectrum cytokeratin IHC staining for OM detection, for example staining of intra-nodal mesothelial cells. (Less)
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organization
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type
Contribution to journal
publication status
published
subject
in
Virchows Archiv: an international journal of pathology
volume
464
issue
4
pages
429 - 434
publisher
Springer
external identifiers
  • pmid:24573319
  • wos:000334174000005
  • scopus:84899071021
ISSN
1432-2307
DOI
10.1007/s00428-014-1558-x
language
English
LU publication?
yes
id
bba63f3b-b8e1-4fb3-866b-b2edd4dcf0f5 (old id 4333882)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24573319?dopt=Abstract
date added to LUP
2014-03-05 17:54:31
date last changed
2017-01-01 04:05:11
@article{bba63f3b-b8e1-4fb3-866b-b2edd4dcf0f5,
  abstract     = {Immunohistochemical (IHC) staining for the identification of nodal occult metastases (OM), not detected by routine histological examination, has been proposed for improved staging, prognostication and decision of adjuvant treatment in surgically treated primary lung cancer. In a prospective study, we analysed 178 cases of primary lung cancer stage I-III (N0-N1) for OM by immunostaining lymph node tissue using a broad-spectrum anti-cytokeratin antibody. OM were found in 7 (4 %) of the 178 cases. Using Kaplan-Meier analysis, overall survival was not significantly different between cases with stage I and cases upstaged to stage II because of OM (n = 3), or between cases with stage II and cases upstaged to stage III (n = 4). Likewise, the presence of OM was not significantly correlated with overall survival in univariable or multivariable Cox proportional hazards regression models, also when disregarding OM &lt;0.2 mm in size. Given the low frequency of OM and lack of significant impact on survival in our study, the justification for including IHC staining of lymph nodes in lung cancer in clinical practise does not appear convincing. Moreover, we report several potential pitfalls in the use of broad-spectrum cytokeratin IHC staining for OM detection, for example staining of intra-nodal mesothelial cells.},
  author       = {Jönsson, Per and Johansson, Leif and Planck, Maria and Brunnström, Hans},
  issn         = {1432-2307},
  language     = {eng},
  number       = {4},
  pages        = {429--434},
  publisher    = {Springer},
  series       = {Virchows Archiv:  an international journal of pathology},
  title        = {Lack of supportive evidence for the use of immunohistochemical staining to identify occult regional lymph node metastases in primary lung cancer.},
  url          = {http://dx.doi.org/10.1007/s00428-014-1558-x},
  volume       = {464},
  year         = {2014},
}