Comparison of Molecular Testing Methodologies for CIC-Rearranged Sarcomas.

Context.--: Molecular detection of a capicua transcriptional repressor (CIC) rearrangement is critical for diagnosing CIC-rearranged sarcoma (CIC-RS) but is analytically challenging. Objective.--: To compare the technical performance of fluorescence in situ hybridization (FISH), whole-transcriptome...

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Published in:Archives of Pathology & Laboratory Medicine Vol. 149; no. 10; pp. 913 - 922
Main Authors: Koo, Selene C., Cardenas, Maria, Stow, Patricia, Neary, Jennifer, Wheeler, David A., Shi, Zonggao, Furtado, Larissa V.
Format: pictorial research tables/charts Journal Article
Published: College of American Pathologists Oct2025
Online Access:View this record in EBSCOhost
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      dt: Oct2025
      vid: 149
      iid: 10
      pid: 2550
      pub: College of American Pathologists
      place: Northfield, Illinois
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        188603687
        188603687
        188603687
        10.5858/arpa.2024-0407-OA
        188603687
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        atl: Comparison of Molecular Testing Methodologies for CIC-Rearranged Sarcomas.
      aug:
        au:
          Koo, Selene C.
          Cardenas, Maria
          Stow, Patricia
          Neary, Jennifer
          Wheeler, David A.
          Shi, Zonggao
          Furtado, Larissa V.
        affil: Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee
      sug:
        subj:
          Sarcoma Diagnosis
          Sarcoma Familial and Genetic
          In Situ Hybridization, Fluorescence
          Gene Expression Profiling
          Sequence Analysis
          DNA Methylation
          RNA Analysis
          Human
          Retrospective Design
          Prospective Studies
          Tennessee
          Genetic Techniques
          Histocytochemistry
          False Negative Results
          Tertiary Health Care
          Hospitals, Pediatric
          Infant
          Child, Preschool
          Child
          Adolescence
          Adult
          Middle Age
          Male
          Female
          Gene Expression
          Descriptive Statistics
          Infant: 1-23 months
          Child, Preschool: 2-5 years
          Child: 6-12 years
          Adolescent: 13-18 years
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Male
          Female
      ab: Context.--: Molecular detection of a capicua transcriptional repressor (CIC) rearrangement is critical for diagnosing CIC-rearranged sarcoma (CIC-RS) but is analytically challenging. Objective.--: To compare the technical performance of fluorescence in situ hybridization (FISH), whole-transcriptome sequencing (RNA-seq), and DNA methylation profiling for CIC-rearrangement detection in a large, mainly pediatric cohort. Design.--: The study cohort consisted of 44 distinct patient tumors that were positive, equivocal, or suggestive for CIC rearrangement, including 18 central nervous system and 26 extra-central nervous system solid tumors. Forty tumors underwent FISH to detect CIC rearrangement, 31 underwent transcriptome sequencing, and 34 underwent methylation array analysis. Results for tumors tested by multiple testing modalities were compared. Results.--: Fusions were detected in 27 cases: CIC::double homeobox 4 (DUX4) (n = 15), CIC::NUT midline carcinoma family member 1 (NUTM1) (n = 4), CIC::leucine twenty homeobox (LEUTX) (n = 3), CIC::NUT family member 2B (NUTM2B) (n = 1), ataxin 1 (ATXN1)::NUTM1 (n = 1), ATXN1::NUT family member 2A/B (NUTM2A/B) (n = 1), CIC::DUX4 proximity effect (n = 1), and dedicator of cytokinesis 1 (DOCK1)::DUX4 (n = 1). Twenty-five tumors were tested by all 3 testing modalities. Apparent false-negative rates were 20% (3 of 15) for CIC FISH, 14% (2 of 14) for transcriptome sequencing, and 14% (2 of 14) for methylation array analysis. Both false-negative methylation array results had CIC::LEUTX fusion. Conclusions.--: Awareness of molecular testing pitfalls in the appropriate detection of CIC rearrangement is critical. Any CIC FISH result may need to be further confirmed, either with unequivocal immunohistochemical support or by another molecular method. A positive RNA-seq or methylation array analysis result may be sufficient evidence for a diagnosis of CIC-RS in the appropriate histologic context. A negative or inconclusive/unclassified RNA-seq or methylation array analysis result in a tumor with high initial suspicion for CIC-RS likely requires careful reevaluation.
      pubtype: Academic Journal
      doctype:
        pictorial
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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