Homer Robert J
From Yale University School of Medicine, New Haven, CT, and VA CT HealthCare System, Pathology and Laboratory Medicine Service, West Haven, CT.
Am J Clin Pathol. 2015 May;143(5):701-6. doi: 10.1309/AJCPNBWF55VGKOIW.
A long-standing problem in lung cancer pathology has been to determine whether two anatomically distinct foci of lung carcinoma are independent primaries or intrapulmonary metastases. While several proposals exist with respect to this problem, it is not known how pathologists use these proposals in actual practice.
We performed a voluntary survey of the Pulmonary Pathology Society, a self-selected group of pathologists with a specialty interest in pulmonary pathology, to determine their opinion on staging various specific scenarios of multiple foci of lung cancer.
We found that there was a great deal of disagreement and uncertainty in the approach to these scenarios unless there were also unambiguous molecular markers or a dramatic difference in histology.
Pathologists have a high degree of uncertainty and disagreement on staging multiple lung carcinomas. An improved pathologic method is required to distinguish separate primary tumors from intrapulmonary metastases. Until that is available, improved nomenclature is needed to convey the intrinsic uncertainty of the situation.
肺癌病理学中一个长期存在的问题是确定两个解剖学上不同的肺癌病灶是独立的原发性肿瘤还是肺内转移瘤。虽然针对这个问题有几种提议，但尚不清楚病理学家在实际工作中如何运用这些提议。
我们对肺病理学会进行了一项自愿调查，该学会是一群对肺病理学有专业兴趣的病理学家的自选组织，以确定他们对多种肺癌病灶的各种特定情况进行分期的看法。
我们发现，除非有明确的分子标记或组织学上有显著差异，否则在处理这些情况的方法上存在大量分歧和不确定性。
病理学家在对多个肺癌进行分期时存在高度的不确定性和分歧。需要一种改进的病理学方法来区分原发性肿瘤和肺内转移瘤。在有可用方法之前，需要改进命名法来传达这种情况的内在不确定性。
