The Skin Hospital, Sydney, New South Wales, Australia.
University Hospital La Paz, Madrid, Spain.
Australas J Dermatol. 2021 Feb;62(1):41-46. doi: 10.1111/ajd.13382. Epub 2020 Aug 18.
BACKGROUND/OBJECTIVES: Therapeutic approaches to keratinocyte carcinoma rely on the accuracy of the biopsy to correctly identify, grade or subtype the tumour. Several studies have investigated the frequency and nature of histopathological discordance between the biopsy and final excision specimen. We analysed information extracted from an Australian Mohs micrographic surgery (MMS) database and compared similar studies.
An Australian MMS database was retrospectively reviewed for a period of one year. Correlation was made between the preoperative lesion diagnosis based on the formal pathology report and the histopathological results reported at the time of MMS. A systematic PubMed review of similar articles was also performed.
A total of 464 cancers (406 BCC and 58 SCC) in 399 patients were included. The overall discrepancy rate in the histopathological classification of keratinocyte carcinoma in our study (42.2%) and the proportion of cases in which the biopsy underestimated the aggressiveness of the tumour (12.9%) were consistent with those found in similar studies. The percentage of biopsies that failed to identify an aggressive BCC subtype (31.6%), and that of biopsy-proven superficial BCC that demonstrated an invasive component in MMS (79.3%), were higher in our study than in comparable studies. The high prevalence of mixed histopathological subtypes, especially amongst BCC with discordant histopathological results, appeared as an important contributing factor.
Despite subtle differences, the results from this Australian study support the results from similar studies and highlight that the biopsy report should be carefully interpreted in combination with the clinical findings.
背景/目的：针对角化细胞癌的治疗方法依赖于活检的准确性，以正确识别、分级或确定肿瘤的亚型。有几项研究调查了活检与最终切除标本之间在组织病理学上的不一致性的频率和性质。我们分析了从澳大利亚 Mohs 显微外科手术（MMS）数据库中提取的信息，并比较了类似的研究。
对澳大利亚 MMS 数据库进行了为期一年的回顾性分析。将术前根据正式病理报告做出的病变诊断与 MMS 时报告的组织病理学结果进行了比较。还对类似文章进行了系统的 PubMed 综述。
共纳入 399 例患者的 464 例癌症（406 例基底细胞癌和 58 例鳞状细胞癌）。在我们的研究中，角化细胞癌的组织病理学分类的总体差异率（42.2%）以及活检低估肿瘤侵袭性的病例比例（12.9%）与类似研究一致。我们的研究中活检未能识别侵袭性 BCC 亚型的比例（31.6%）以及活检证实的浅表 BCC 在 MMS 中显示侵袭性成分的比例（79.3%）高于类似研究。混合组织病理学亚型的高患病率，尤其是在组织病理学结果不一致的 BCC 中，似乎是一个重要的促成因素。
尽管存在细微差异，但这项澳大利亚研究的结果支持类似研究的结果，并强调活检报告应与临床发现相结合进行仔细解读。
