Shukla Saumya, Malhotra Kiran Preet, Husain Nuzhat, Gupta Anurag, Anand Nidhi
Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Cytol. 2015 Jul-Sep;32(3):159-64. doi: 10.4103/0970-9371.168838.
Pulmonary adenocarcinoma harbors various molecular abnormalities that include epidermal growth factor mutation, anaplastic lymphoma kinase gene re-arrangement, K-RAS mutations. The availability of targeted therapy against these molecular markers has revolutionized personalized medicine. Accurate cytological diagnosis of pulmonary adenocarcinoma will aid in utilising the cytology smears for molecular testing.
The objective of this retrospective study was to evaluate the diagnostic efficacy of various cytology samples in the diagnosis of pulmonary adenocarcinoma.
The study included a retrospective case series of 50 patients with biopsy proven non small cell lung carcinoma of adenocarcinoma subtype. The corresponding cytology reports of all the 50 cases were analyzed for different samples including broncho-alveolar lavage (BAL), bronchial washings, bronchial brush smears, pleural fluid, sputum and guided fine needle aspiration cytology (FNAC) of lung and metastatic lymph nodes. The overall cyto-diagnosis efficacy as well that of various cytological samples were analyzed.
Multiple cytology samples were received in 14 of 50 cases. The overall diagnostic efficacy of the various cytology samples in the diagnosis of malignancy was 78% and 66.6% cases were accurately typed as non small cell lung carcinoma-adenocarcinoma. The best cytological sample for the detection of pulmonary adenocarcinoma was bronchial brush smears which had a detection rate of 70%. In fine needle aspiration cytology samples and bronchial washings the detection rate was 65.5% and 25% respectively.
In cases where the cytological diagnosis is certain the tissue biopsies can be simultaneously tested for EGRF and ALK gene mutations. Repeat biopsies are often required due to small amount of tumor tissue or necrotic biopsies. Alternate use of cytological specimen for molecular testing can be done when a diagnosis of pulmonary adenocarcinoma is established.
肺腺癌存在多种分子异常，包括表皮生长因子突变、间变性淋巴瘤激酶基因重排、K-RAS突变。针对这些分子标志物的靶向治疗的出现彻底改变了个性化医疗。肺腺癌的准确细胞学诊断将有助于利用细胞学涂片进行分子检测。
本回顾性研究的目的是评估各种细胞学样本在肺腺癌诊断中的诊断效能。
该研究包括一个回顾性病例系列，共50例经活检证实为腺癌亚型的非小细胞肺癌患者。分析了所有50例病例相应的细胞学报告中的不同样本，包括支气管肺泡灌洗（BAL）、支气管冲洗液、支气管刷片、胸水、痰液以及肺和转移淋巴结的引导细针穿刺细胞学检查（FNAC）。分析了总体细胞诊断效能以及各种细胞学样本的诊断效能。
50例中有14例收到了多个细胞学样本。各种细胞学样本在恶性肿瘤诊断中的总体诊断效能为78%，66.6%的病例被准确分类为非小细胞肺癌-腺癌。检测肺腺癌的最佳细胞学样本是支气管刷片，检测率为70%。在细针穿刺细胞学样本和支气管冲洗液中，检测率分别为65.5%和25%。
在细胞学诊断确定的情况下，可以同时对组织活检进行EGRF和ALK基因突变检测。由于肿瘤组织量少或活检坏死，通常需要重复活检。当确诊为肺腺癌时，可以交替使用细胞学标本进行分子检测。
