Bright-Field Dual-Color Chromogenic In Situ Hybridization for Diagnosing Echinoderm Microtubule-Associated Protein-Like 4-Anaplastic Lymphoma Kinase-Positive.

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Bright-Field Dual-Color Chromogenic In Situ Hybridization for Diagnosing Echinoderm Microtubule-Associated Protein-Like 4-Anaplastic Lymphoma Kinase-Positive Lung Adenocarcinomas Akihiko Yoshida, MD, Koji Tsuta, MD, PhD, Hiroaki Nitta, PhD, Yutaka Hatanaka, PhD, Hisao Asamura, MD, Ikuo Sekine, MD, PhD, Thomas M. Grogan, MD, Masashi Fukayama, MD, PhD, Tatsuhiro Shibata, MD, PhD, Koh Furuta, MD, PhD, Takashi Kohno, PhD, Hitoshi Tsuda, MD, PhD Journal of Thoracic Oncology Volume 6, Issue 10, Pages 1677-1686 (October 2011) DOI: 10.1097/JTO.0b013e3182286d25 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Schematic design of the break-apart probe set for anaplastic large cell lymphoma (ALK) gene. ALK break-apart probe set was designed to hybridize with the neighboring centromeric (5′ probe labeled with digoxigenin) and telomeric (3′ probe labeled with 2,4 dinitrophenyl) sequence of ALK gene. Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Anaplastic lymphoma kinase (ALK) break-apart chromogenic in situ hybridization (CISH) signals were categorized into the following seven patterns. Blue signal represents 5′ region to ALK, and red signal represents 3′ to ALK. A, fused 3′/5′ only; (B) fused 3′/5′ and split; (C) split only; (D) fused 3′/5′ and isolated 5′; (E) fused 3′/5′ and isolated 3′; (F) isolated 5′ only; and (G) isolated 3′ only (ALK-break-apart CISH, ×1000). Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 A, The results of an anaplastic lymphoma kinase (ALK) break-apart chromogenic in situ hybridization assay represented as a bar chart. Yellow, red, blue, and gray areas represent the percentages of tumor cells with split signals (fused and split signals or just split signals), isolated 3′ signals (fused and red signals or just red signals), isolated 5′ signals (fused and blue signals or just blue signals), and only fused signals, respectively. A combination of the yellow and red areas shows the rate of rearrangement-positive cells. B, The results of an ALK break-apart fluorescence in situ hybridization assay represented as a bar chart. Yellow, orange, green, and gray areas represent the percentages of tumor cells with split signals (fused and split signals or just split signals), isolated 3′ signals (fused and orange signals or just orange signals), isolated 5′ signals (fused and green signals or just green signals), and only fused signals, respectively. A combination of the yellow and orange areas shows the rate of rearrangement-positive rate. Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 A, anaplastic lymphoma kinase (ALK) break-apart chromogenic in situ hybridization in an echinoderm microtubule-associated protein-like 4 (EML4)-ALK-positive lung adenocarcinoma (P1) displayed a significant number of rearrangement signals (arrows, split and lone 3′ signals, ALK-break-apart CISH, ×600). B, EML4-ALK-negative carcinoma (N1) predominantly showed 3′/5′ fused signals that looked purple or black due to colocalization of red and blue signals (ALK-break-apart CISH, ×600). Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 A, The only CISH false-negative case (P4) harbored a large number of cells displaying isolated 5′ signals unaccompanied by 3′ signals (ALK-break-apart CISH, ×1000). B, This atypical profile was replicated by fluorescence in situ hybridization (FISH) as predominantly lone 5′ green signal pattern (ALK-break-apart FISH, ×1000). Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6 Anaplastic lymphoma kinase (ALK) immunohistochemistry diffusely stained all the echinoderm microtubule-associated protein-like 4 (EML4)-ALK-positive lung adenocarcinomas, and it was negative in all the EML4-ALK-negative cases (A, negative; B, weakly positive; C, moderately positive; and D, strongly positive. ALK immunohistochemistry, ×200). Journal of Thoracic Oncology 2011 6, 1677-1686DOI: (10.1097/JTO.0b013e3182286d25) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions