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Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer

  • Authors:
    • Shouxiang Zhao
    • Yuhong Liu
    • Tao Wang
    • Ying Li
    • Ze Chen
    • Xiaoshan Cai
  • View Affiliations / Copyright

    Affiliations: Department of Pathology, Weifang No. 2 People's Hospital, Weifang, Shandong 261041, P.R. China, Department of Pathology, Anqiu Hospital of Traditional Chinese Medicine, Weifang, Shandong 262100, P.R. China
    Copyright: © Zhao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 2
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    Published online on: October 21, 2025
       https://doi.org/10.3892/etm.2025.12997
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Abstract

In the present study, the diagnostic capability of pleural effusion cell blocks for immunohistochemistry and epidermal growth factor receptor (EGFR) mutation detection in advanced lung cancer was explored. Samples of pleural effusion were collected from 231 patients with advanced lung cancer, treated at Weifang No. 2 People's Hospital (Weifang, China) from July 2018 to December 2022, and were transformed into cellular blocks by embedding them in paraffin. Lung cancer subtypes were determined using immunohistochemical staining, and EGFR gene mutations were identified through the use of the amplification refractory mutation system technology (ADx‑ARMS). Of the 231 specimens analyzed by immunohistochemistry, 222 were adenocarcinoma, seven were small cell carcinoma and two were squamous cell carcinoma. EGFR testing was performed on 161 lung adenocarcinoma cases, revealing an EGFR mutation rate of 52.8% (85/161). The mutations discovered in the EGFR gene encompassed L858R in exon 21 (49 instances), deletion of exon 19 (31 instances), L861Q in exon 21 (2 instances), G719X in exon 18 (1 instance), a co‑mutation of G719X/L861Q (1 instance) and a co‑mutation of S768I/G719X (1 instance). The EGFR mutation rate was significantly higher in female patients with lung adenocarcinoma (32.30%) compared with that in male patients (20.50%) (P<0.05). Furthermore, patients with EGFR‑mutant lung adenocarcinoma undergoing treatment with EGFR tyrosine kinase inhibitors exhibited a significantly extended survival rate compared with those with wild‑type EGFR receiving chemotherapy. In conclusion, the present study demonstrated that immunohistochemistry with pleural effusion cell blocks can aid in clarifying the histological subtype of lung cancer, and enable EGFR mutation detection, which can effectively guide molecular targeted therapy.
View Figures

Figure 1

Histological classification of cell
blocks from pleural effusion in patients with lung cancer. (A)
Cancer cells were arranged in glandular patterns (blue arrow) in
the cell block of pleural effusion from a patient with lung
adenocarcinoma (hematoxylin and eosin staining).
Immunohistochemical staining showing (B) thyroid transcription
factor-1 and (C) napsin A positivity in lung adenocarcinoma. (D)
Immunohistochemical staining showing P40 positivity in lung
squamous cell carcinoma. Immunohistochemical staining showing (E)
synaptophysin and (F) CD56 positivity in lung small cell
carcinoma.

Figure 2

EGFR gene mutation analysis. (A) EGFR
exon 21 L858R mutation. (B) EGFR exon 19del mutation. (C) Results
of EGFR gene mutation analysis. del, deletion; EGFR, epidermal
growth factor receptor.

Figure 3

Evaluation of overall survival rate in
patients with EGFR mutations, detected in cell block samples of
pleural effusion. Solid lines represent cumulative survival rate
and dashed lines indicate the confidence interbal. EGFR mutation
(n=36) and EGFR wild-type (n=65). EGFR, epidermal growth factor
receptor.
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Copy and paste a formatted citation
Spandidos Publications style
Zhao S, Liu Y, Wang T, Li Y, Chen Z and Cai X: Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer. Exp Ther Med 31: 2, 2026.
APA
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., & Cai, X. (2026). Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer. Experimental and Therapeutic Medicine, 31, 2. https://doi.org/10.3892/etm.2025.12997
MLA
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., Cai, X."Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer". Experimental and Therapeutic Medicine 31.1 (2026): 2.
Chicago
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., Cai, X."Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer". Experimental and Therapeutic Medicine 31, no. 1 (2026): 2. https://doi.org/10.3892/etm.2025.12997
Copy and paste a formatted citation
x
Spandidos Publications style
Zhao S, Liu Y, Wang T, Li Y, Chen Z and Cai X: Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer. Exp Ther Med 31: 2, 2026.
APA
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., & Cai, X. (2026). Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer. Experimental and Therapeutic Medicine, 31, 2. https://doi.org/10.3892/etm.2025.12997
MLA
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., Cai, X."Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer". Experimental and Therapeutic Medicine 31.1 (2026): 2.
Chicago
Zhao, S., Liu, Y., Wang, T., Li, Y., Chen, Z., Cai, X."Application of pleural effusion cell blocks for immunohistochemistry and EGFR gene mutation testing for advanced lung cancer". Experimental and Therapeutic Medicine 31, no. 1 (2026): 2. https://doi.org/10.3892/etm.2025.12997
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