Isaka Tetsuya, Yokose Tomoyuki, Miyagi Yohei, Washimi Kota, Nishii Teppei, Ito Hiroyuki, Nakayama Haruhiko, Yamada Kouzo, Masuda Munetaka
Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan.
Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
Pathol Int. 2017 Oct;67(10):487-494. doi: 10.1111/pin.12570. Epub 2017 Aug 31.
It currently remains unclear whether tumor spread through airspaces (STAS) actually exist in vivo or are an artifact. The morphologies of STAS and tumor cell clusters in airway secretions collected from the segmental or lobar bronchus of resected lung adenocarcinomas and squamous cell carcinomas were compared among 48 patients. The EGFR status of tumor cell clusters in airway secretions was also compared with that of the main tumor in EGFR mutant adenocarcinomas. Tumor cell clusters were observed in the airway secretion cytology of ten patients (20.8%), and eight patients were adenocarcinoma (20.0% of adenocarcinoma). The morphology of STAS closely resembled that of tumor cell clusters detected in airway secretion cytology. The positive rates of airway secretion cytology were 83.3%, 100%, and 50% in papillary adenocarcinoma, micropapillary adenocarcinoma, and invasive mucinous adenocarcinoma, respectively. Among three EGFR mutant adenocarcinomas, the EGFR mutation subtypes of the main tumors in FFPE sections and tumor cell clusters in airway secretions were identical. These indicate that STAS may be detected in the airway secretion cytology. STAS is common in papillary or micropapillary adenocarcinoma and may spread as far as the segmental or lobar bronchus at the time of surgery.
目前尚不清楚肿瘤气腔播散（STAS）在体内是否实际存在，还是一种假象。对48例患者切除的肺腺癌和肺鳞癌段或叶支气管收集的气道分泌物中STAS和肿瘤细胞簇的形态进行了比较。还比较了EGFR突变型腺癌气道分泌物中肿瘤细胞簇与主要肿瘤的EGFR状态。10例患者（20.8%）的气道分泌细胞学检查中观察到肿瘤细胞簇，其中8例为腺癌（占腺癌的20.0%）。STAS的形态与气道分泌细胞学检查中检测到的肿瘤细胞簇非常相似。乳头状腺癌、微乳头状腺癌和浸润性黏液腺癌的气道分泌细胞学阳性率分别为83.3%、100%和50%。在3例EGFR突变型腺癌中，FFPE切片中的主要肿瘤和气道分泌物中的肿瘤细胞簇的EGFR突变亚型相同。这些表明STAS可能在气道分泌细胞学检查中被检测到。STAS在乳头状或微乳头状腺癌中常见，在手术时可能扩散至段或叶支气管。
