Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Pathology, Yale School of Medicine, New Haven, CT.
Am J Clin Pathol. 2020 Jan 2;153(2):165-174. doi: 10.1093/ajcp/aqz149.
The aim of this study was to devise reproducible biopsy criteria for distinguishing pulmonary large cell neuroendocrine carcinoma (LCNEC) from non-small cell lung carcinoma (NSCLC).
Tissue microarrays of LCNEC and NSCLC were generated from resection specimens and used as biopsy surrogates. They were stained for neuroendocrine markers, Ki-67, napsin-A, and p40, and independently analyzed by standardized morphologic criteria by four pathologists. Tumors were scored based on morphology, neuroendocrine marker expression, and Ki-67 proliferative index.
The average total score for LCNEC was significantly higher than for NSCLC (5.65 vs 0.51, P < .0001). Utilizing a cutoff score of 4 or higher showed 100% sensitivity and 99% specificity for LCNEC diagnosis, with an excellent agreement among four pathologists (98%).
The proposed semiquantitative approach based on a combination of specific morphologic and immunophenotypic features may be a useful tool for biopsy diagnosis of LCNEC.
本研究旨在制定可重现的活检标准，以区分肺大细胞神经内分泌癌（LCNEC）与非小细胞肺癌（NSCLC）。
从手术标本中生成 LCNEC 和 NSCLC 的组织微阵列，用作活检替代物。它们被神经内分泌标志物、Ki-67、napsin-A 和 p40 染色，并由四位病理学家根据标准化形态学标准进行独立分析。根据形态、神经内分泌标志物表达和 Ki-67 增殖指数对肿瘤进行评分。
LCNEC 的平均总评分明显高于 NSCLC（5.65 对 0.51，P <.0001）。使用 4 分或更高的截断值显示 LCNEC 诊断的敏感性为 100%，特异性为 99%，四位病理学家之间的一致性极好（98%）。
基于特定形态学和免疫表型特征的组合的拟议半定量方法可能是 LCNEC 活检诊断的有用工具。
