Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, China.
Department of Pathology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, China.
BMC Cancer. 2021 Feb 18;21(1):176. doi: 10.1186/s12885-021-07892-8.
Synchronous multifocal lung cancer (SMLC) is diagnosed with increasing frequency in clinical practice globally. Due to innate variation in clinical management and outcome, it is vital to properly distinguish between synchronous multifocal primary lung cancer (SMPLC) and intrapulmonary metastasis (IM). The pathologic features and principal classification criteria of multifocal lung cancer remain unclear. Our objective was to evaluate the diagnostic value of histological morphologic features and driver gene mutations in SMLC classification.
We collected a unique cohort of Chinese patients with SMLC, and fully explored the morphologic, immunohistochemical, and molecular features of the disease. Twenty-one SMLC patients with a total of 50 tumours were included in our study. The pathological features that were presented by these patients were analysed, including the tumours location, tumours size, pathological types, predominant pattern of adenocarcinoma, and immunohistochemical staining. We conducted molecular testing of nine driver oncogenes that are associated with lung cancer, namely, EGER, KRAS, BRAF, NRAS, ALK, ROS1, RET, HER2, and PIK3CA.
According to the Martini-Melamed classification and refined standard, 8 and 17 patients, respectively, were considered to have SMPLCs. Gene mutations were identified in 18 tumours (36%). Twelve patients had different gene mutations.
We demonstrate that conventional morphological assessment is not sufficient to clearly establish the clonal relationship of SMPLCs. Instead, the evaluation of histological subtypes, including nonmucinous adherent components, is required. Multiplex genotypic analysis may also prove to be a useful additional tool.
同步多原发肺癌（SMLC）在全球临床实践中的诊断频率越来越高。由于临床管理和结果存在固有差异，因此正确区分同步多原发原发性肺癌（SMPLC）和肺内转移（IM）至关重要。多灶性肺癌的病理特征和主要分类标准仍不清楚。我们的目的是评估组织形态学特征和驱动基因突变在 SMLC 分类中的诊断价值。
我们收集了一组独特的中国 SMLC 患者队列，并全面探讨了疾病的形态学、免疫组织化学和分子特征。我们的研究纳入了 21 名 SMLC 患者共 50 个肿瘤。分析了这些患者的病理特征，包括肿瘤位置、肿瘤大小、病理类型、腺癌的主要模式以及免疫组织化学染色。我们对与肺癌相关的 9 个驱动致癌基因（EGER、KRAS、BRAF、NRAS、ALK、ROS1、RET、HER2 和 PIK3CA）进行了分子检测。
根据 Martini-Melamed 分类和细化标准，分别有 8 名和 17 名患者被认为患有 SMPLC。在 18 个肿瘤（36%）中发现了基因突变。12 名患者具有不同的基因突变。
我们证明常规形态学评估不足以明确确立 SMPLC 的克隆关系。相反，需要评估组织学亚型，包括非粘液性黏附成分。多重基因分析也可能证明是一种有用的附加工具。
