The Utility of CDX2 and CK20 Immunohistochemical Reactivity to Distinguish Adenocarcinomas of the Lung From Their Benign Mimics.
* Context.--Distinguishing benign from malignant processes in small lung biopsy specimens is challenging, particularly in the presence of architectural distortion and crush artifacts. Mimics include reactive type II pneumocytes in peribronchiolar metaplasia or organizing pneumonia and benign mucinou...
| Published in: | Archives of Pathology & Laboratory Medicine Vol. 150; no. 5; pp. 360 - 365 |
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| Main Authors: | , , , , , , , , |
| Format: | pictorial research tables/charts Journal Article |
| Published: |
College of American Pathologists
May2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194029173&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194029173 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039985 1FS jtl: Archives of Pathology & Laboratory Medicine issn: 00039985 maglogo: N pubinfo: dt: May2026 vid: 150 iid: 5 pid: 2550 pub: College of American Pathologists place: Northfield, Illinois artinfo: ui: 194029173 194029173 194029173 10.5858/arpa.2025-0271-OA 194029173 ppf: 360 ppct: 5 formats: fmt: @attributes: type: P tig: atl: The Utility of CDX2 and CK20 Immunohistochemical Reactivity to Distinguish Adenocarcinomas of the Lung From Their Benign Mimics. aug: au: Li, Jiannan Sandhu, Ariel Smith, Maxwell Larsen, Brandon T. Tazelaar, Henry D. Bernadt, Cory T. Ritter, Jon H. Lin, Chieh-Yu Wein, Alexander N. affil: Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri sug: subj: Adenocarcinoma of Lung Pathology Adenocarcinoma of Lung Diagnosis CDX2 Transcription Factor Diagnostic Use Proteins Diagnostic Use Tumor Markers, Biological Analysis Immunohistochemistry Methods Diagnosis, Differential Human United States Retrospective Design Record Review CDX2 Transcription Factor Metabolism Proteins Metabolism Metaplasia Pathology Hyperplasia Pathology Precancerous Conditions Pathology Adenocarcinoma in Situ Pathology Carcinoma, Non-Small-Cell Lung Pathology Bronchioles Pathology Biopsy, Needle Methods Specimen Handling Sensitivity and Specificity Predictive Value of Tests False Negative Results False Positive Results Descriptive Statistics ab: * Context.--Distinguishing benign from malignant processes in small lung biopsy specimens is challenging, particularly in the presence of architectural distortion and crush artifacts. Mimics include reactive type II pneumocytes in peribronchiolar metaplasia or organizing pneumonia and benign mucinous elements, including goblet cells and submucosal glands, which can mimic adenocarcinoma with mucinous features. Objective.--To understand whether caudal-type homeobox 2 (CDX2) and cytokeratin 20 (CK20) immunoreactivity is specific to malignant epithelial processes and evaluate their expression in a range of benign, premalignant, and malignant pulmonary lesions. Design.--We assessed CDX2 and CK20 immunohistochemistry in 48 cases of interstitial lung disease with reactive type II pneumocytes, 13 foci of atypical adenomatous hyperplasia, 11 bronchiolar adenomas, 4 adenocarcinomas in situ, 25 minimally invasive adenocarcinomas, 39 pulmonary adenocarcinomas with mucinous features, 6 mucoepidermoid carcinomas, and 1 squamous papilloma with goblet cell hyperplasia. Results.--No expression of CDX2 or CK20 was observed in reactive processes, goblet cells, bronchial glands, atypical adenomatous hyperplasia, or bronchiolar adenomas. In adenocarcinomas with mucinous features (n = 39), 9 (23%) were CK20-reactive and 8 (20%) were CDX2-reactive. A minority of nonmucinous and mucinous minimally invasive adenocarcinomas (n = 25) showed immunoreactivity (3 [12%] for each marker), while all in situ adenocarcinomas were negative. Conclusions.--Our findings demonstrate that CDX2 and CK20 are not expressed in benign or reactive type II pneumocytes and are specific for malignancy, particularly adenocarcinomas with mucinous features. Immunoreactivity with either marker in small biopsy specimens can support a diagnosis of malignancy, especially in morphologically equivocal or limited samples. Absence of staining does not exclude malignancy, but immunoreactivity with CDX2 and/or CK20 provides strong supportive evidence for a malignant process. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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