AttendMe Owl Logo
AttendMe
Sign In
All Pathways
PathologyDiagnostic

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.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    IHC Panel Selection

    Choose appropriate panel based on differential

    1. ◆
      Decision

      Morphologic Category

      Initial classification by H&E

      • Carcinoma (epithelial)
      • Sarcoma (mesenchymal)
      • Melanoma
      • Lymphoma/Leukemia
      • Neuroendocrine
      • Undifferentiated/Unknown
      1. ●
        Action

        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)
        1. ●
          Action

          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)
          1. ●
            Action

            IHC Reporting

            Standardized reporting

            • Clone and vendor
            • Percentage positive (when applicable)
            • Intensity (weak, moderate, strong)
            • Pattern (nuclear, cytoplasmic, membranous)
            • Interpretation and differential
        2. ●
          Action

          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
        3. ●
          Action

          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)
        4. ●
          Action

          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
      2. ●
        Action

        Melanoma Panel

        Confirm melanocytic origin

        • S100 (sensitive)
        • SOX10 (sensitive)
        • Melan-A/MART-1 (specific)
        • HMB-45 (specific)
        • PRAME (distinguish from nevi)
        • Ki-67 (prognostic)
      3. ●
        Action

        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)
      4. ●
        Action

        Neuroendocrine Panel

        Confirm and grade

        • Synaptophysin (sensitive)
        • Chromogranin (specific)
        • INSM1 (sensitive)
        • Ki-67 (grading)
        • TTF-1 (lung NET)
        • CDX2 (midgut)

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

Related Pathology Pathways

Bone Marrow Biopsy Systematic Interpretation

Diagnostic

Coagulation Disorder Workup Algorithm (ISTH)

Diagnostic

Critical Values Reporting Protocol (CAP)

Management

Flow Cytometry Immunophenotyping Interpretation

Diagnostic

Next steps

Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.

Calculator

Body Mass Index

Weight classification based on height and weight

Open page

Compare

AttendMe.ai vs UpToDate

See how this pathway workflow compares against UpToDate.

Open page

Commercial

Start free

Run the pathway in a live AttendMe account with citations and tracked usage.

Start free

Related Resources

All Clinical PathwaysClinical CalculatorsAI Chat with Auto-Detection

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.

Get AI-Powered Analysis Alongside This Algorithm

In AttendMe.ai, the IHC Panel Selection by Tumor Type (ASCO/CAP) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.

Try AttendMe Free