51
Chapter 6: Comparison of Different Assay Platforms for ALK Testing
IHC
Negative 0/1+
Equivocal 2+
Positive 3+
Figure 2. Algorithm to predict ALK gene rearrangement with use of IHC and CISH or FISH. Modified, with permission, from Kim H, Yoo S-B, Choe J-Y, et al. Detection of ALK gene rearrangement in non-small cell lung cancer. J Thorac Oncol. 2011;6(8):1359-1366.
Reported as ALK negative
CISH/FISH
Reported as ALK positive
IHC
Negative 0/1+
Equivocal 2+
Positive 3+
Figure 3. Diagnostic algorithm using ALK IHC and FISH) in NSCLC. Modified, with permission, from Paik J, Choe G, Kim H, et al. Screening of anaplastic lymphoma kinase rearrangement by immunohistochemistry in non-small cell lung cancer: correlation with fluorescence in situ hybridization. J Thorac Oncol. 2011;6(3):466-472.
Reported as ALK negative
FISH
Reported as ALK positive
NSCLC ALK testing IHC
Figure 4. Proposed algorithm for ALK testing in NSCLC if ALK IHC becomes fully validated. Modified, with permission, from Thunnissen E, Bubendorf L, Dietel M, et al. EML4-ALK testing in non-small cell carcinomas of the lung: a review with recommendations. Virchows Arch. 2012;461(3):245-257.
Negative
Positive 1+, 2+, 3+
FISH
Negative
Positive
No ALK rearrangement
ALK rearrangement