Miyata K, Morita S, Dejima H, Seki N, Matsutani N, Mieno M, Kondo F, Soejima Y, Tanaka F, Sawabe M
Department of Pathology, Teikyo University Hospital, Tokyo, Japan.
Department of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Diagn Cytopathol. 2017 Nov;45(11):963-970. doi: 10.1002/dc.23800. Epub 2017 Aug 23.
ALK gene rearrangement is an important class of gene mutations in pulmonary adenocarcinoma. ALK-positive pulmonary adenocarcinoma exhibits characteristic histological features, such as signet ring cell carcinoma (SRCC) and a mucinous cribriform structure. However, when insufficient histological specimens are obtained, ALK-positivity must be predicted based on cytological features. The purpose of this study was to clarify the cytological characteristics of ALK-positive pulmonary adenocarcinoma.
We compared the cytological findings of 16 ALK-positive cases with 40 ALK-negative cases. We examined various cytoplasmic features of SRCC, including the presence of pink, yellow, or orange mucin; green, vacuolar, or vesicular cytoplasm; and green globular cytoplasmic secretions. We also examined whether the SRCC cells exhibited a pattern of individually scattered cells, the formation of cell clusters, and formation of a mucinous cribriform pattern.
A univariate analysis showed that significantly frequent cytological findings included pink mucin, green cytoplasm, vacuolar cytoplasm, vesicular cytoplasm, green globular cytoplasmic secretions, an individually scattered pattern, cluster formation, and a mucinous cribriform structure (all, P < .05). A stepwise multivariate logistic regression analysis identified three significant contributing factors: pink mucin (P = .03), vesicular cytoplasm (P = .06), and an individually scattered pattern (P = .01) of SRCC. If the specimens showed two or three of these features, the sensitivity and specificity were both 88% for the prediction of ALK-positive cancers.
Three cytological features of SRCC (pink mucin, vesicular cytoplasm, and an individually scattered pattern) could be useful cytological markers for the prediction of ALK-positive pulmonary adenocarcinoma.
ALK基因重排是肺腺癌中一类重要的基因突变。ALK阳性肺腺癌具有特征性组织学特征，如印戒细胞癌（SRCC）和黏液筛状结构。然而，当获取的组织学标本不足时，必须根据细胞学特征预测ALK阳性。本研究的目的是阐明ALK阳性肺腺癌的细胞学特征。
我们比较了16例ALK阳性病例与40例ALK阴性病例的细胞学结果。我们检查了SRCC的各种细胞质特征，包括粉红色、黄色或橙色黏液的存在；绿色、空泡状或小泡状细胞质；以及绿色球状细胞质分泌物。我们还检查了SRCC细胞是否表现为单个散在细胞模式、细胞簇的形成以及黏液筛状模式的形成。
单因素分析显示，显著常见的细胞学结果包括粉红色黏液、绿色细胞质、空泡状细胞质、小泡状细胞质、绿色球状细胞质分泌物、单个散在模式、簇形成和黏液筛状结构（所有P < 0.05）。逐步多因素逻辑回归分析确定了三个显著的影响因素：SRCC的粉红色黏液（P = 0.03）、小泡状细胞质（P = 0.06）和单个散在模式（P = 0.01）。如果标本显示出这些特征中的两个或三个，则预测ALK阳性癌症的敏感性和特异性均为88%。
SRCC的三个细胞学特征（粉红色黏液、小泡状细胞质和单个散在模式）可能是预测ALK阳性肺腺癌的有用细胞学标志物。
