Heterogeneity of Anaplastic Lymphoma Kinase Gene Rearrangement in Non–Small-Cell Lung Carcinomas: A Comparative Study Between Small Biopsy and Excision.

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Heterogeneity of Anaplastic Lymphoma Kinase Gene Rearrangement in Non–Small-Cell Lung Carcinomas: A Comparative Study Between Small Biopsy and Excision Samples Hideyuki Abe, CT, Akihiko Kawahara, CT, PhD, Koichi Azuma, MD, PhD, Tomoki Taira, CT, Yorihiko Takase, CT, Chihiro Fukumitsu, CT, Kazuya Murata, CT, PhD, Tomohiko Yamaguchi, CT, PhD, Jun Akiba, MD, PhD, Hidenobu Ishii, MD, Isamu Okamoto, MD, PhD, Tomoaki Hoshino, MD, PhD, Shinzou Takamori, MD, PhD, Masayoshi Kage, MD, PhD Journal of Thoracic Oncology Volume 10, Issue 5, Pages 800-805 (May 2015) DOI: 10.1097/JTO.0000000000000507 Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Representative signal findings are shown for the different cellular positive (split or single orange) and negative (fused or single green) patterns for anaplastic lymphoma kinase (ALK) by fluorescence in situ hybridization (FISH). A, Negative ALK-FISH pattern. The signals are either overlapping, adjacent, or less than two signal diameters apart. B, Classic ALK-FISH positive pattern. Classic break apart pattern shows one fused, one orange, and one green signal in a cell. C, ALK-FISH positive pattern. One fused orange and green signal and one orange signal only. D, ALK-FISH positive pattern. One fused, two broken apart signals, and one orange signal only. Journal of Thoracic Oncology 2015 10, 800-805DOI: (10.1097/JTO.0000000000000507) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Representative images of hematoxylin and eosin stain, ALK immunohistochemistry, and ALK fluorescence in situ hybridization in a H2228 cell line. Journal of Thoracic Oncology 2015 10, 800-805DOI: (10.1097/JTO.0000000000000507) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 A, Patient 10 was positive for ALK immunohistochemistry and ALK fluorescence in situ hybridization (FISH) assay in both small biopsy and excision specimens. B, Patient 15 was positive for ALK immunohistochemistry in both small biopsy and excision specimens. The excision specimen of this patient was positive (≥15% cells with ALK rearrangement), whereas the ALK rearrangement score of biopsy was 9% for ALK FISH. Journal of Thoracic Oncology 2015 10, 800-805DOI: (10.1097/JTO.0000000000000507) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 A Patient 18, in whom surgical resection of primary lung cancer was not possible, was positive for ALK only by immunohistochemistry. B, She received crizotinib and showed a partial response. Journal of Thoracic Oncology 2015 10, 800-805DOI: (10.1097/JTO.0000000000000507) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions