Immunohistochemical screening for anaplastic lymphoma kinase (ALK) rearrangement in advanced non-small cell lung cancer patients

Heae Surng Park, June Koo Lee, Dong Wan Kim, Kimary Kulig, Tae Min Kim, Se Hoon Lee, Yoon Kyung Jeon, Doo Hyun Chung, Dae Seog Heo

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112 Scopus citations


Fluorescence in situ hybridization (FISH) is currently used to detect non-small cell lung cancer (NSCLC) patients with anaplastic lymphoma kinase (ALK) gene rearrangement, who are candidates for ALK inhibitor therapy. However, FISH may not be a practical method for screening for ALK-positive patients in a large population due to its cost and difficulty in interpretation. We investigated the role of immunohistochemistry (IHC) to screen for ALK rearrangement in advanced NSCLC. We identified 1,166 stage IIIB or IV NSCLC patients with non-squamous histology from the Seoul National University Hospital NSCLC database. To enrich ALK-positive cases, we selected 262 patients who were either EGFR wild-type or non-responders to previous EGFR tyrosine kinase inhibitors (TKI). ALK IHC and ALK FISH were performed on formalin-fixed, paraffin-embedded tissue. ALK protein was expressed in 28 (10.7%) tumors in 262 patients. ALK FISH was positive in 25 (9.5%) cases. All patients with IHC score of 3 (n= 9) were FISH-positive and all patients with score of 0 (n= 234) were FISH-negative. Among patients with IHC scores of 1 and 2, five (83.3%, 5/6) and eleven (84.6%, 11/13) were FISH-positive, respectively. The sensitivity and specificity of ALK IHC with intensity score of 1 or more were 100% and 98.7%, respectively. IHC can be a useful test for screening ALK FISH-positive cases in advanced NSCLC. FISH testing should be considered for advanced NSCLC patients with tumors showing mild to moderate staining for ALK by IHC to confirm ALK translocation.

Original languageEnglish
Pages (from-to)288-292
Number of pages5
JournalLung Cancer
Issue number2
StatePublished - Aug 2012

Bibliographical note

Funding Information:
This study was supported by a grant of the Korean Health Technology R&D Project , Ministry of Health and Welfare, Republic of Korea (A110057), and was funded in part by an outcomes research agreement with Pfizer.


  • Anaplastic lymphoma kinase
  • Fluorescence in situ hybridization
  • Immunohistochemistry
  • Non-small cell lung carcinoma
  • Screening


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