Raz Dan J, Zell Jason A, Karnezis Anthony N, Odisho Anobel, Ignatius Ou S H, Anton-Culver Hoda, Jablons David M
Department of Surgery, Division of Cardiothoracic Surgery and the UCSF Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94131, USA.
J Thorac Oncol. 2006 Nov;1(9):943-8.
Cytology is commonly used to diagnose non-small cell lung cancer (NSCLC) but is an inaccurate means of diagnosis of bronchioloalveolar carcinoma (BAC). The aims of this study were to calculate the sensitivity and specificity of cytologic diagnosis of BAC and to estimate the misclassification of BAC as other subtypes of NSCLC.
Preoperative fine-needle aspiration cytology diagnoses were compared to histology diagnoses in 222 patients, including 51 patients with pure or mixed BAC, who underwent lung resection for NSCLC at our institution since 1999.
The sensitivity and specificity of a cytologic diagnosis of BAC were 12% and 99%, respectively. Based on cytologic diagnosis, 63% of BAC was misclassified as adenocarcinoma, and 18% was misclassified as undifferentiated NSCLC. In this cohort, 35% of adenocarcinomas and 12% of undifferentiated NSCLC diagnosed by cytology had BAC histology.
Diagnosis of NSCLC by cytology alone results in significant misclassification of BAC, most commonly as adenocarcinoma or undifferentiated NSCLC. Because patients with BAC respond differently to certain treatments such as endothelial growth factor receptor inhibitors and surgical resection of multifocal lung cancer, misclassification of BAC may have important therapeutic implications.
细胞学检查常用于诊断非小细胞肺癌（NSCLC），但对于细支气管肺泡癌（BAC）的诊断是不准确的。本研究的目的是计算BAC细胞学诊断的敏感性和特异性，并评估BAC被误诊为NSCLC其他亚型的情况。
将222例患者术前细针穿刺细胞学诊断结果与组织学诊断结果进行比较，这些患者自1999年以来在我院接受了NSCLC肺切除术，其中包括51例纯BAC或混合BAC患者。
BAC细胞学诊断的敏感性和特异性分别为12%和99%。基于细胞学诊断，63%的BAC被误诊为腺癌，18%被误诊为未分化NSCLC。在该队列中，细胞学诊断为腺癌的患者中有35%以及未分化NSCLC患者中有12%的组织学类型为BAC。
仅依靠细胞学诊断NSCLC会导致BAC出现显著误诊，最常见的是误诊为腺癌或未分化NSCLC。由于BAC患者对某些治疗（如内皮生长因子受体抑制剂和多灶性肺癌的手术切除）的反应不同，BAC的误诊可能具有重要的治疗意义。
