Department of Respiratory Medicine and Thoracic Oncology, Ghent University Hospital, Belgium.
Lung Cancer. 2012 Apr;76(1):46-50. doi: 10.1016/j.lungcan.2011.09.004. Epub 2011 Sep 25.
With endosonography, the diagnosis and staging of non-small cell lung cancer (NSCLC) increasingly relies on small samples. The discrimination between squamous and non-squamous subtypes is now important for therapy tailoring. We analyzed the agreement between fine needle aspirates obtained by endosonography and matched biopsy samples for subtyping NSCLC. Patients with a positive endoscopic fine needle aspirate and a matched biopsy were identified. The level of diagnostic agreement was estimated with biopsy samples as golden standard. In 951 patients investigated with endosonography, we identified 92 with NSCLC on the positive fine needle aspirate and on the matched biopsy. Squamous cell carcinoma was diagnosed in 34 (37%) and 44 (48%) of fine needle aspirate and biopsy samples; while non-squamous carcinoma was diagnosed in 58 (63%) and 48 (52%) respectively. The agreement between needle aspirate and biopsy for the subtyping of NSCLC was 76% (kappa=0.52). In cases with cell block preparation, the agreement for subtyping was 96% (kappa=0.91) vs 69% (kappa=0.39) in cases without cell blocks. Therefore, the diagnostic agreement between endosonographic fine needle aspirates and biopsy specimens for subtyping NSCLC is moderate with a disagreement in 1 out of 4 patients. However, cell block preparation increased the agreement and thus the reliability of the fine needle specimens obtained during endosonography, for subtyping NSCLC considerably. In conclusion, for patients with NSCLC in whom subtyping is relevant, a diagnostic technique yielding larger samples (FNA with cell block preparation or biopsies) should be preferred.
通过内镜超声检查，非小细胞肺癌（NSCLC）的诊断和分期越来越依赖于小样本。区分鳞状和非鳞状亚型对于治疗方案的制定非常重要。我们分析了内镜超声检查获得的细针抽吸物与匹配活检样本在非小细胞肺癌亚型分类中的一致性。确定了内镜超声检查阳性且有匹配活检的患者。以活检样本作为金标准来评估诊断一致性的水平。在对 951 例患者进行内镜超声检查中，我们在阳性细针抽吸物和匹配活检中发现了 92 例 NSCLC。在细针抽吸物和活检样本中，诊断为鳞状细胞癌的分别为 34 例（37%）和 44 例（48%）；而非鳞状细胞癌的分别为 58 例（63%）和 48 例（52%）。细针抽吸物和活检用于 NSCLC 亚型分类的一致性为 76%（kappa=0.52）。在进行细胞块制备的情况下，亚型分类的一致性为 96%（kappa=0.91），而未进行细胞块制备的情况下为 69%（kappa=0.39）。因此，内镜超声检查细针抽吸物和活检标本在 NSCLC 亚型分类中的诊断一致性为中等，4 例中有 1 例存在分歧。然而，细胞块制备增加了一致性，从而大大提高了内镜超声检查获得的细针标本在 NSCLC 亚型分类中的可靠性。总之，对于需要进行亚型分类的 NSCLC 患者，应选择能提供更大样本的诊断技术（带有细胞块制备的细针抽吸或活检）。
