一种半定量评分系统可辅助经支气管活检对肺大细胞神经内分泌癌做出诊断。
A Semiquantitative Scoring System May Allow Biopsy Diagnosis of Pulmonary Large Cell Neuroendocrine Carcinoma.
机构信息
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Pathology, Yale School of Medicine, New Haven, CT.
出版信息
Am J Clin Pathol. 2020 Jan 2;153(2):165-174. doi: 10.1093/ajcp/aqz149.
Abstract
OBJECTIVES
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).
METHODS
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.
RESULTS
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%).
CONCLUSIONS
The proposed semiquantitative approach based on a combination of specific morphologic and immunophenotypic features may be a useful tool for biopsy diagnosis of LCNEC.
摘要
目的
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）。
方法
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。
结果
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%）。
结论
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。
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