p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2

Our plain-English summary of p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2, by T. Tatsumori, K. Tsuta, K. Masai, et al (Applied Immunohistochemistry & Molecular Morphology, 2014).

The study

• Authors: T. Tatsumori, K. Tsuta, K. Masai, T. Kinno, T. Taniyama, A. Yoshida, K. Suzuki, H. Tsuda
• Journal: Applied Immunohistochemistry & Molecular Morphology
• Published: 2014;22(5):377-82
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Histologic distinction among non-small cell lung carcinomas, particularly between squamous cell carcinoma (SQC) and adenocarcinoma (ADC), has become more important. Recently, a p40 antibody was suggested to be a highly specific marker for SQC. We evaluated p40 expression and compared it with the expression of other SQC markers in 580 primary lung carcinomas, including 158 SQCs, 156 ADCs, 50 carcinoid tomors, 107 large cell neuroendocrine carcinomas, 68 small cell lung carcinomas, and 41 malignant mesotheliomas. Detailed histologic distributions of p40-positive cases were as follows: 153 (96.8%) of 158 SQCs, 7 (4.6%) of 152 ADCs, 0 (0%) of 50 carcinoid tomors, 4 (3.6%) of 107 large cell neuroendocrine carcinomas, 1 (1.5%) of 68 small cell lung carcinomas, and 1 (2.4%) of 41 mesotheliomas. p40 staining yields high sensitivity as well as high specificity for distinguishing SQC from ADC, neuroendocrine carcinomas, and malignant mesothelioma.

In plain English

This laboratory study from the National Cancer Center Hospital in Tokyo, Japan, tested which tissue stain best identifies squamous cell carcinoma, a type of lung cancer. The authors stained surgically removed tumors from 580 cases: 158 squamous cell carcinomas and 422 other tumors, including adenocarcinomas, neuroendocrine lung tumors and 41 malignant mesotheliomas. They compared a newer marker, p40, with four others: p63, CK5/6, desmocollin-3 and Sox2. Some of the data on the older markers had been reported by the same group before. p40 was positive in 153 of 158 squamous cell carcinomas (96.8%) and in 13 of 418 other tumors (3.1%), including 1 of 41 mesotheliomas. CK5/6, by contrast, was positive in 26 of 41 mesotheliomas. In a statistical comparison, p40 separated squamous cell carcinoma from the other tumors best (area under the curve 0.967), ahead of CK5/6 (0.933). The authors concluded that p40 was highly accurate in distinguishing squamous cell carcinoma from adenocarcinoma, neuroendocrine carcinomas and malignant mesothelioma. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Laboratory (immunohistochemistry) study comparing diagnostic tissue markers on surgically resected tumors, presented as an update of the authors' earlier studies
• Who was studied: 580 surgically resected tumors at the National Cancer Center Hospital, Tokyo, Japan: 158 lung squamous cell carcinomas and 422 non-squamous tumors (156 adenocarcinomas, 50 carcinoid tumors, 107 large cell neuroendocrine carcinomas, 68 small cell carcinomas, 41 malignant mesotheliomas). Dates are not given.
• Main results:
  • p40 was positive in 153 of 158 squamous cell carcinomas (96.8%).
  • Among non-squamous tumors, p40 was positive in 7 (4.6%) of 152 adenocarcinomas, 4 (3.6%) of 107 large cell neuroendocrine carcinomas, 1 (1.5%) of 68 small cell carcinomas and 1 (2.4%) of 41 mesotheliomas.
  • For telling squamous cell carcinoma apart from all other tumors, p40 had a sensitivity of 96.8% and a specificity of 96.9%.
  • p63 had a sensitivity of 97.4% and a specificity of 72.8% for squamous cell carcinoma.
  • CK5/6 was positive in 26 (63.4%) of 41 mesotheliomas.
  • In ROC analysis, p40 had the largest area under the curve (0.967), followed by CK5/6 (0.933), desmocollin-3 (0.881), p63 (0.849) and Sox2 (0.696).
  • Among two-marker combinations, only p40 plus desmocollin-3 (AUC 0.966) came close to p40 alone (0.967).
• The authors' conclusion: The authors concluded that p40 has both high sensitivity and high specificity for distinguishing squamous cell carcinoma from adenocarcinoma, neuroendocrine carcinomas and malignant mesothelioma. They predicted that p40 will replace p63 as the standard squamous cell carcinoma marker.
• Limitations the authors state:
  • The authors noted that sensitivity was slightly lower than the 100% reported elsewhere. They attributed this probably to differences in patient numbers and tumor sample size.
  • The authors noted that the specificity of p40 was not higher than that of desmocollin-3.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Squamous Cell Carcinoma, Cytokeratin 5/6, Carcinoma, Adenocarcinoma, Malignant Mesothelioma, Mesothelioma.

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