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IHC Panel Selection by Tumor Type (ASCO/CAP)

IHC Panel Selection by Tumor Type (ASCO/CAP): IHC Panel Selection → Morphologic Category → Carcinoma Panel → Breast Cancer Predictive → IHC Reporting.

Pathway Overview

11 steps

Algorithm Steps

11 total

  1. 01Start

    IHC Panel Selection

    Choose appropriate panel based on differential

  2. 02Decision

    Morphologic Category

    Initial classification by H&E

    • Carcinoma (epithelial)
    • Sarcoma (mesenchymal)
    • Melanoma
    • Lymphoma/Leukemia
    • Neuroendocrine
    • Undifferentiated/Unknown
  3. 03Action

    Carcinoma Panel

    Determine primary site

    • CK7/CK20 pattern
    • TTF-1 (lung, thyroid)
    • CDX2 (GI)
    • PAX8 (kidney, gynecologic)
    • GATA3 (breast, urothelial)
    • PSA/NKX3.1 (prostate)
    • Napsin-A (lung adenocarcinoma)
  4. 04Action

    Breast Cancer Predictive

    Required biomarkers

    • ER (threshold ≥1%)
    • PR (threshold ≥1%)
    • HER2 (IHC 0, 1+, 2+, 3+)
    • If HER2 2+: FISH reflex
    • Ki-67 (prognostic)
  5. 05Action

    IHC Reporting

    Standardized reporting

    • Clone and vendor
    • Percentage positive (when applicable)
    • Intensity (weak, moderate, strong)
    • Pattern (nuclear, cytoplasmic, membranous)
    • Interpretation and differential
  6. 06Action

    Colorectal Cancer Markers

    Lynch and predictive

    • MMR panel: MLH1, MSH2, MSH6, PMS2
    • If MLH1 loss: BRAF V600E IHC or MLH1 methylation
    • Consider HER2 for metastatic
    • PDL1 if MSI-H
  7. Path rejoins step 05Shared downstream outcome
  8. 07Action

    Lung Cancer Markers

    Predictive and diagnostic

    • TTF-1, Napsin-A (adenocarcinoma)
    • p40, CK5/6 (squamous)
    • PDL1 (TPS for pembrolizumab)
    • ALK, ROS1 IHC (reflex to FISH)
    • Consider molecular panel (NGS)
  9. Path rejoins step 05Shared downstream outcome
  10. 08Action

    Carcinoma Unknown Primary

    Systematic approach

    • CK7+/CK20-: Lung, breast, ovary, pancreatobil
    • CK7-/CK20+: Colorectal
    • CK7+/CK20+: Upper GI, pancreas, urothelial
    • CK7-/CK20-: RCC, HCC, SCC
    • Site-specific markers to narrow
  11. Path rejoins step 05Shared downstream outcome
  12. 09Action

    Melanoma Panel

    Confirm melanocytic origin

    • S100 (sensitive)
    • SOX10 (sensitive)
    • Melan-A/MART-1 (specific)
    • HMB-45 (specific)
    • PRAME (distinguish from nevi)
    • Ki-67 (prognostic)
  13. Path rejoins step 05Shared downstream outcome
  14. 10Action

    Sarcoma Panel

    Subtype classification

    • SMA, desmin (smooth/skeletal muscle)
    • S100, SOX10 (nerve sheath)
    • CD34 (DFSP, SFT)
    • MDM2 (liposarcoma)
    • TLE1 (synovial sarcoma)
    • STAT6 (solitary fibrous tumor)
  15. Path rejoins step 05Shared downstream outcome
  16. 11Action

    Neuroendocrine Panel

    Confirm and grade

    • Synaptophysin (sensitive)
    • Chromogranin (specific)
    • INSM1 (sensitive)
    • Ki-67 (grading)
    • TTF-1 (lung NET)
    • CDX2 (midgut)
  17. Path rejoins step 05Shared downstream outcome

Guideline Source

ASCO/CAP IHC Guidelines and WHO Classification

DOI: 10.1200/JCO.2016.68.6757View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • IHC interpretation requires clinical correlation
  • Panels are suggestions, not exhaustive
  • Sensitivity/specificity varies by antibody clone
  • Quality control essential
  • Molecular testing increasingly supplements IHC

Applicable Regions

USAUUKEU

AU: RCPA IHC recommendations

UK: RCPath IHC standards

US: ASCO/CAP biomarker guidelines

Version 1Next review: 2027-01-01

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Frequently Asked Questions

What is the IHC Panel Selection by Tumor Type (ASCO/CAP)?

The IHC Panel Selection by Tumor Type (ASCO/CAP) is a diagnostic clinical algorithm for Pathology. It provides a structured decision tree to guide clinical decision-making, based on ASCO/CAP IHC Guidelines and WHO Classification.

What guideline is the IHC Panel Selection by Tumor Type (ASCO/CAP) based on?

This algorithm is based on ASCO/CAP IHC Guidelines and WHO Classification (DOI: 10.1200/JCO.2016.68.6757).

What are the limitations of the IHC Panel Selection by Tumor Type (ASCO/CAP)?

Known limitations include: IHC interpretation requires clinical correlation; Panels are suggestions, not exhaustive; Sensitivity/specificity varies by antibody clone; Quality control essential; Molecular testing increasingly supplements IHC. Individual patient factors may require deviation from these recommendations.

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