Matsuzawa Reiko, Kirita Keisuke, Kuwata Takeshi, Umemura Shigeki, Matsumoto Shingo, Fujii Satoshi, Yoh Kiyotaka, Kojima Motohiro, Niho Seiji, Ohmatsu Hironobu, Ochiai Atsushi, Tsuboi Masahiro, Goto Koichi, Ishii Genichiro
Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Japan; Department of Thoracic Oncology, National Cancer Center Hospital East, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital East, Japan.
Lung Cancer. 2016 Apr;94:1-6. doi: 10.1016/j.lungcan.2016.01.009. Epub 2016 Jan 22.
Lung adenocarcinoma is heterogeneous, characterized by various histological subtypes. Determination of the predominant histological subtype (lepidic, papillary, acinar or solid-predominant) has been shown to correlate with genetic abnormalities and clinicopathological features. Although subtyping using small biopsy samples is important for tailored approaches to clinical management, limited data exist on the concordance of predominant subtype between resected specimens and biopsy specimens.
We compared the diagnosed predominant subtypes in resected specimens and matched biopsy specimens in a series of 327 lung adenocarcinomas. The accuracy of preoperative diagnosis by biopsy and the factors that influence concordance with resected specimen analysis were examined.
In 211 of the 326 patients (66.0%), the predominant adenocarcinoma subtype diagnosed from biopsy matched the findings of resection analysis. Overall, the concordance rate in biopsy samples with larger tumor areas (≥ 0.7 mm(2)) was significantly higher than in those with smaller tumor area (<0.7 mm(2); 71.2% vs 60.7%, respectively; p=0.015). In the biopsy samples with smaller tumor areas, the concordance rate was 77% in lepidic subtype, 71% in papillary subtype, 60% in solid subtype, and 40% in acinar subtype. Concordance rate in the biopsy samples with larger tumor area was higher in papillary and solid subtypes (88% and 76%, respectively), but remained low in acinar subtype (37%).
The current results indicate that accuracy of adenocarcinoma subtyping based on small biopsy samples is influenced by tumor area. Our study also suggests that subtyping of acinar histology using biopsy specimen is particularly error-prone.
肺腺癌具有异质性，由多种组织学亚型构成。已证实，确定主要组织学亚型（鳞屑状、乳头状、腺泡状或实性为主型）与基因异常及临床病理特征相关。尽管使用小活检样本进行亚型分类对于临床管理的个体化方法很重要，但关于切除标本与活检标本之间主要亚型的一致性数据有限。
我们比较了327例肺腺癌患者的切除标本和匹配活检标本中诊断出的主要亚型。研究了活检术前诊断的准确性以及影响与切除标本分析一致性的因素。
在326例患者中的211例（66.0%）中，活检诊断的主要腺癌亚型与切除分析结果相符。总体而言，肿瘤面积较大（≥0.7平方毫米）的活检样本的一致性率显著高于肿瘤面积较小（<0.7平方毫米）的样本（分别为71.2%和60.7%；p=0.015）。在肿瘤面积较小的活检样本中，鳞屑状亚型的一致性率为77%，乳头状亚型为71%，实性亚型为60%，腺泡状亚型为40%。肿瘤面积较大的活检样本中，乳头状和实性亚型的一致性率较高（分别为88%和76%），但腺泡状亚型的一致性率仍然较低（37%）。
目前的结果表明，基于小活检样本的腺癌亚型分类准确性受肿瘤面积影响。我们的研究还表明，使用活检标本对腺泡状组织学进行亚型分类特别容易出错。
