Correlation of IHC and FISH for ALK gene rearrangement in non-small cell lung carcinoma: IHC score algorithm for FISH

Eunhee S. Yi, Jennifer M. Boland, Joseph J. Maleszewski, Anja C. Roden, Andre M. Oliveira, Marie Christine Aubry, Michele R. Erickson-Johnson, Bolette L. Caron, Yan Li, Hui Tang, Shawn Stoddard, Jason Wampfler, Kimary Kulig, Ping Yang

Research output: Contribution to journalArticlepeer-review

239 Scopus citations


Introduction: Accurate, cost-effective methods for testing anaplastic lymphoma kinase gene rearrangement (ALK+) are needed to select patients with non-small cell lung carcinoma for ALK-inhibitor therapy. Fluorescent in situ hybridization (FISH) is used to detect ALK+, but it is expensive and not routinely available. We explored the potential of an immunohistochemistry (IHC) scoring system as an affordable, accessible approach. Methods: One hundred one samples were obtained from an enriched cohort of never-smokers with adenocarcinoma from the Mayo Clinic Lung Cancer Cohort. IHC was performed using the ALK1 monoclonal antibody with ADVANCE detection system (Dako) and FISH with dual-color, break-apart probe (Abbott Molecular) on formalin-fixed, paraffin-embedded tissue. Results: Cases were assessed as IHC score 0 (no staining; n = 69), 1+ (faint cytoplasmic staining, n = 21), 2+ (moderate, smooth cytoplasmic staining; n = 3), or 3+ (intense, granular cytoplasmic staining in ≤10% of tumor cells; n = 8). All IHC 3+ cases were FISH+, whereas 1 of 3 IHC 2+ and 1 of 21 IHC 1+ cases were FISH+. All 69 IHC 0 cases were FISH-. Considering FISH a gold-standard reference in this study, sensitivity and specificity of IHC were 90 and 97.8%, respectively, when 2+ and 3+ were regarded as IHC positive and 0 and 1+ as IHC negative. Conclusions: IHC scoring correlates with FISH and may be a useful algorithm in testing ALK+ by FISH in non-small cell lung carcinoma, similar to human epidermal growth factor-2 testing in breast cancer. Further study is needed to validate this approach.

Original languageEnglish (US)
Pages (from-to)459-465
Number of pages7
JournalJournal of Thoracic Oncology
Issue number3
StatePublished - Mar 2011


  • Adenocarcinoma
  • Anaplastic lymphoma kinase
  • Fluorescent in situ hybridization
  • Immunohistochemistry
  • Non-small cell lung carcinoma

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'Correlation of IHC and FISH for ALK gene rearrangement in non-small cell lung carcinoma: IHC score algorithm for FISH'. Together they form a unique fingerprint.

Cite this