Iranian Journal of Pathology

Evaluation of TTF-1, Napsin A, p40, and p63 in the Subtyping of Non–Small Cell Lung Carcinoma: A Cross-Sectional Study from India

Document Type : Original Research

Authors

Surbhi Patel
Deepa Sowkur Anandarama Adiga

Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India

https://doi.org/10.30699/ijp.2025.2042277.3362
Abstract
Background & Objective: Subtyping non–small cell lung carcinoma (NSCLC) into adenocarcinoma (ADC) and squamous cell carcinoma (SCC) is crucial for selecting appropriate molecular tests, as driver mutations are often subtype-specific. This study aimed to evaluate the utility of TTF-1, Napsin A, p40, and p63 immunohistochemical (IHC) markers in subtyping NSCLC on small biopsies, with the goal of identifying a minimal marker panel.
Methods: This retrospective, cross-sectional study was conducted at Kasturba Medical College, Mangalore, from January 2014 to December 2020. All NSCLC cases diagnosed during the study period were included. Immunohistochemical expressions of TTF-1, Napsin A, p40, and p63 was evaluated and correlated with morphological findings.
Results: Ninety-five NSCLC cases were included: adenocarcinoma (n = 35), squamous cell carcinoma (n = 57), and NSCLC-not otherwise specified (NOS) (n = 2). IHC reclassification based on marker expression resulted in six ADC cases retyped as SCC and eight SCC cases retyped as ADC. TTF-1 and Napsin A expression were significantly associated with adenocarcinoma (p < 0.001), while p40 and p63 expression were significantly associated with SCC (p < 0.001).
Conclusion: IHC is essential in overcoming the diagnostic limitations of small biopsy specimens, especially in morphologically heterogeneous tumors. A minimal panel comprising TTF-1 and p40 is sufficient for accurate subtyping of NSCLC and can help preserve tissue for downstream molecular testing.

Keywords

Lung Cancer
Adenocarcinoma
Squamous cell carcinoma
TTF-1
Napsin A
p40
p63

Subjects

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Iranian Journal of Pathology
Volume 20, Issue 3
Summer 2025
Pages 297-306

  • Receive Date 06 January 2025
  • Revise Date 19 February 2025
  • Accept Date 11 April 2025

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