RT Journal Article
SR Electronic
T1 IHC versus FISH versus NGS to detect ALK gene rearrangement in NSCLC: all questions answered?
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 405
OP 409
DO 10.1136/jclinpath-2021-207408
VO 75
IS 6
A1 Batra, Ullas
A1 Nathany, Shrinidhi
A1 Sharma, Mansi
A1 Pasricha, Sunil
A1 Bansal, Abhishek
A1 Jain, Parveen
A1 Mehta, Anurag
YR 2022
UL http://jcp.bmj.com/content/75/6/405.abstract
AB Aims Anaplastic lymphoma kinase (ALK) rearranged non-small cell lung carcinoma (NSCLC) is a distinct molecular subtype and rapid approval of ALK tyrosine kinase inhibitors (TKIs) has necessitated rapid and sensitive diagnostic modalities for the detection of this alteration. Gene rearrangements can be identified using many techniques including fluorescence in situ hybridisation (FISH), reverse transcriptase-PCR, next-generation sequencing (NGS) and immunohistochemistry (IHC) for fusion oncoprotein expression. We aimed to determine the concordance between IHC, FISH and NGS for ALK biomarker detection, and determine differences in sensitivity, and survival outcomes.Methods We analysed the concordance between IHC using D5F3 monoclonal antibody, FISH (break-apart) and NGS using a custom panel containing 71 different ALK variants.Results Among 71 cases included in this study, FISH was evaluable in 58 cases. The concordance of ALK IHC with FISH was 75.9% and that with NGS was 84.5%. The sensitivities of FISH and NGS were 75.6% and 87.5%, respectively. The median progression-free survival of ALK IHC-positive and FISH-negative group was 5.5 months and that of both positive was 9.97 months.Conclusion Although NGS offers a better throughput and visualisation, IHC still remains the quintessential screening tool in upfront diagnosis of ALK rearranged NSCLC.Data are available on reasonable request. All data relevant to the manuscript have been presented here. Any additional data required will be made available from the corresponding author on reasonable request.