Fascin immunoreactivity for preoperatively predicting lymph node metastases in peripheral adenocarcinoma of the lung 3cm or less in diameter

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Abstract
Objective: Fascin is an actin-bundling protein that induces cell membrane protrusions and increases the motility of normal and transformed epithelial cells. We evaluated the expression of fascin by performing immunohistochemistry to determine its role in the progression of small-size peripheral lung adenocarcinomas and to elucidate its utility as a preoperative novel therapeutic option. Methods: Immunohistochemistry for fascin was performed in 49 peripheral adenocarcinomas of ≤3 cm in diameter on the conventional whole tissue (CWT) sections and 2 mm-sized tissue microarray (TMA) cores that were the substitute for preoperative biopsy samples. Staining of more than 5% of tumor cells was recorded as positive immunoreactivity. The distribution of fascin labeling was measured according to the percentage of fascin-positive cells: 5–25% (low grade) and >25% (high grade). Results: Overall, fascin immunoreactivity was detected in 30 (61.2%) out of the total 49 cases. The tumors with high-grade fascin immunoreacivity tended to more frequently show lymph node metastasis (P = 0.0007), lymphovascular invasion (P = 0.0084) and a higher stage (P = 0.05). There was no significant association with age, gender, tumor size and the histological subtype. The 2 mm-sized TMA cores, which were considered as a substitute for percutaneous needle biopsy sample in this study, showed concordant results with the CWT section (κ = 0.836). Conclusions: We suggest that fascin immunoreactivity may identify the subsets of peripheral adenocarcinomas of the lung 3 cm or less in diameter that have a different potential to metastasize to the regional lymph nodes. The evaluation of fascin immunoreactivity on the preoperative biopsy sample could be a novel therapeutic strategy for selecting the most appropriate therapy for small-size pulmonary adenocarcinomas.

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