Background: Inhibition of the oncogenic fusion-gene EML4-ALK is a current first-line approach for patients with\nstage IV non-small cell lung cancer. While FISH was established as the gold standard for identifying these patients,\nthere is accumulating evidence that other methods of detection, i.e., immunohistochemistry and next-generation\nsequencing (NGS), exist that may be equally successful. However, the concordance of these methods is under\ninvestigation.\nCase presentation: Adding to the current literature, we here report a 56 year old female never-smoker with stage\nIV lung adenocarcinoma whose biopsy was IHC and FISH inconclusive but positive in NGS. Retroactive profiling of\nthe resection specimen corroborated fusion reads obtained by NGS, FISH-positivity and showed weak ALK-positivity\nby IHC. Consequently, we diagnosed the case as ALK-positive rendering the patient eligible to crizotinib treatment.\nConclusions: With IHC on biopsy material only, this case would have been overlooked withholding effective\ntherapy.
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