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IHC Panels with reporting - Lung Neoplasm

Cancer
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Details

Tumor immunohistochemistry panels.

₹11,322₹16,174

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IHC Panels with Reporting - Lung Neoplasm

  • Why is it done?
    • Test measures the expression of specific protein markers using immunohistochemistry (IHC) technique on lung tumor tissue samples to identify the histological type and subtype of lung neoplasms
    • Differentiates between adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and other lung cancer subtypes for accurate diagnosis and treatment planning
    • Identifies therapeutic targets such as PD-L1, ALK, ROS1, and EGFR mutations to guide personalized cancer therapy and immunotherapy eligibility
    • Performed on tissue obtained from lung biopsy, surgical resection, or cytology specimens when lung malignancy is suspected or confirmed
    • Typically ordered when histological classification is unclear on initial light microscopy or when molecular/targeted therapy consideration is clinically relevant
  • Normal Range
    • Negative Result: No staining or minimal (<1%) immunoreactivity detected for the specific marker; indicates absence of the target protein or antigen
    • Positive Result: Specific staining pattern visible in tumor cells (typically ≥1% positive cells); indicates presence of the target marker with clinical significance
    • Scoring System: Often reported on scale of 0-3+ or as percentage of cells staining (0-100%); interpretation depends on specific marker and clinical context
    • Common Markers and Normal Interpretation:
    • TTF-1 (Thyroid Transcription Factor-1): Positive in adenocarcinoma and small cell carcinoma; usually negative in squamous cell carcinoma
    • p63/CK5/CK6: Positive in squamous cell carcinoma; typically negative in adenocarcinoma
    • PD-L1: Expression level (typically <1%, 1-49%, or ≥50%) predicts immunotherapy response; higher levels suggest better response to checkpoint inhibitors
    • ALK and ROS1: Negative in most non-small cell lung cancers; positive results identify fusion gene presence and indicate targeted therapy eligibility
  • Interpretation
    • Adenocarcinoma Classification: TTF-1 positive, Napsin-A positive, CK7 positive, p63 negative indicates peripheral-type lung adenocarcinoma with favorable prognosis compared to central-type
    • Squamous Cell Carcinoma: p63 positive, CK5/CK6 positive, TTF-1 typically negative; helps exclude adenocarcinoma and directs chemotherapy selection
    • Small Cell Carcinoma: TTF-1 positive, Chromogranin-A positive, CD56 positive, synaptophysin positive; requires different treatment approach with chemotherapy and radiation
    • PD-L1 Expression Interpretation: High expression (≥50%) strongly predicts response to immunotherapy and is basis for monotherapy with checkpoint inhibitors; intermediate levels (1-49%) may benefit from combination therapy; low/negative (<1%) typically requires conventional chemotherapy or combination approaches
    • Fusion Gene Positivity: ALK positive or ROS1 positive results identify patients eligible for specific tyrosine kinase inhibitors (ALK inhibitors or ROS1 inhibitors) with dramatic clinical response rates; dramatically improves prognosis and treatment outcomes
    • Pattern Recognition: Panel interpretation requires evaluation of multiple markers together; conflicting markers may indicate mixed adenocarcinoma-squamous cell carcinoma or poorly differentiated carcinoma requiring additional testing or clinical correlation
    • Factors Affecting Results: Tissue fixation, processing quality, antibody quality, staining technique variations, and interpretation expertise influence IHC results; inadequate tissue or poor quality samples may require repeat testing or alternative diagnostic methods
    • Prognostic Significance: Specific marker combinations correlate with survival outcomes; presence of tumor-associated macrophages and necrosis patterns also provide prognostic information beyond simple classification
  • Associated Organs
    • Primary Organ: Lungs (respiratory system); directly evaluates malignant tissue in pulmonary parenchyma, bronchial walls, or pleura
    • Common Associated Malignancies:
    • Adenocarcinoma (40% of lung cancers): Most common type, often peripheral location, associated with non-smokers and younger patients; better prognosis than squamous cell carcinoma
    • Squamous Cell Carcinoma (25-30% of lung cancers): Central airway location, strong association with smoking history, more aggressive behavior
    • Small Cell Carcinoma (10-15% of lung cancers): Highly aggressive, rapid metastasis, neuroendocrine features, very poor prognosis without early treatment
    • Large Cell Carcinoma (10-15% of lung cancers): Undifferentiated histology, poor prognosis, rapidly progressive disease
    • Secondary Organs Involved in Metastatic Disease:
    • Brain: Most common site for distant metastasis; associated with neurological symptoms and poor prognosis
    • Liver: Frequent metastatic site; indicates advanced stage IV disease and reduced survival
    • Adrenal glands: Common site of metastasis; may cause endocrine dysfunction
    • Bones: Bone metastases cause pain and pathological fractures; associated with poor prognosis
    • Mediastinal lymph nodes: Regional progression; indicates advanced stage disease
    • Potential Complications:
    • Airway obstruction from tumor growth; respiratory failure requiring intubation or tracheostomy
    • Malignant pleural effusion: Fluid accumulation causing dyspnea and poor prognosis
    • Superior vena cava syndrome: Venous obstruction causing facial swelling and shortness of breath
    • Pericardial effusion or cardiac tamponade: Life-threatening complication from tumor invasion
    • Esophageal compression: Dysphagia and nutritional complications
    • Horner syndrome: From apical tumor invasion of sympathetic chain; causes ptosis and miosis
  • Follow-up Tests
    • Molecular Testing (if not included in initial panel):
    • EGFR mutation testing: PCR or NGS to detect activating mutations predicting response to EGFR inhibitors (gefitinib, erlotinib, afatinib)
    • KRAS mutation analysis: Identifies patients with KRAS mutations for novel targeted therapies and predicts chemotherapy resistance
    • MET amplification testing: Fluorescence in situ hybridization (FISH) for ALK rearrangements not detected by IHC alone
    • Staging and Metastatic Disease Workup:
    • CT chest with contrast: Evaluates primary tumor size, local invasion, mediastinal involvement, and pleural effusion
    • Brain MRI: Detects cerebral metastases in approximately 10% of patients; required baseline for treatment planning
    • PET-CT scan: Identifies distant metastases, evaluates mediastinal lymph nodes, and assesses disease extent for stage determination
    • Bone scan or skeletal scintigraphy: Detects bone metastases if symptoms present or high-risk features on initial imaging
    • Laboratory Tests:
    • Tumor markers (CEA, CYFRA 21-1): Baseline levels for prognostic stratification and treatment monitoring
    • Complete blood count (CBC): Baseline hematologic parameters before chemotherapy initiation
    • Comprehensive metabolic panel (CMP): Liver and kidney function assessment before targeted therapies or chemotherapy
    • Functional Assessment Tests:
    • Pulmonary function tests (PFTs): Assess respiratory reserve before surgical resection or aggressive chemotherapy; predict treatment tolerance
    • Cardiac evaluation (EKG, echocardiography): Required before anthracycline-containing chemotherapy or thoracic radiation
    • Disease Monitoring During and After Treatment:
    • Repeat CT imaging: Every 4-8 weeks during active chemotherapy; every 3 months during targeted therapy; every 3-6 months in surveillance phase
    • Circulating tumor DNA (ctDNA) or liquid biopsy: Emerging marker for treatment response monitoring and early detection of recurrence
    • Repeat tumor marker measurement: Serial CEA measurements to assess treatment response and detect recurrence
    • Pathology Review (if diagnosis uncertain):
    • Expert pathology consultation: Referral for difficult cases or conflicting IHC results requiring additional expertise
    • Electron microscopy: Occasionally used for neuroendocrine differentiation confirmation in small cell carcinoma
  • Fasting Required?
    • Fasting: No
    • Fasting is not required for IHC panel analysis as this is a tissue-based immunohistochemistry test performed on biopsy or surgical specimens, not a blood test
    • Specimen Collection Requirements:
    • Tissue sample obtained via transbronchial biopsy, bronchoscopy, percutaneous needle biopsy, or surgical resection
    • Specimen must be fixed in 10% neutral buffered formalin immediately after collection to preserve tissue architecture and antigenicity
    • Proper specimen labeling with patient identifiers, site of origin, clinical diagnosis, and date of collection is essential
    • Pre-Procedure Preparation for Biopsy (if specimen not yet obtained):
    • NPO (nothing by mouth) for 4-6 hours before bronchoscopy or biopsy procedure to minimize aspiration risk
    • Discontinue anticoagulation (warfarin, DOACs) and antiplatelet agents (aspirin, clopidogrel) as directed by physician to reduce bleeding complications; timing depends on procedure type and clinical risk
    • Continue essential medications (beta-blockers, antihypertensives) unless specifically instructed otherwise
    • Avoid aspirin-containing products for 5-7 days before procedure; avoid NSAIDs for 3 days prior
    • Obtain informed consent and discuss procedure risks (bleeding, infection, pneumothorax in bronchoscopy) before tissue collection
    • Baseline coagulation studies (PT/INR, aPTT, platelet count) recommended before invasive biopsy procedures
    • Post-Procedure Care:
    • No eating or drinking until local anesthesia effect wears off (usually 2-4 hours) to prevent aspiration
    • Monitor for complications including hemoptysis, chest pain, or dyspnea after transbronchial biopsy
    • Chest X-ray obtained 1-2 hours post-procedure to exclude pneumothorax if transbronchial approach used
    • Turnaround Time:
    • Typically 5-10 business days for routine IHC panel interpretation; rush processing (24-48 hours) available if clinically indicated

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