Department of Pathology, University of Chicago, Chicago, IL, USA.
Department of Pathology and Lab Medicine, University of Wisconsin, Madison, WI, USA.
Am J Clin Pathol. 2021 Nov 8;156(6):989-999. doi: 10.1093/ajcp/aqab054.
Numerous studies on malignant mesothelioma (MM) highlight the prognostic importance of histologic subtype, nuclear grade, and necrosis. This study compares these parameters in paired biopsy and resection specimens of pleural MM.
Histologic subtype, percentage of epithelioid morphology, nuclear grade, and the presence or absence of necrosis were compared in 429 paired biopsies and resection specimens of pleural MM from 19 institutions.
Histologic subtype was concordant in 81% of cases (κ = 0.58). When compared with resection specimens, epithelioid morphology at biopsy had a positive predictive value (PPV) of 78.9% and a negative predictive value (NPV) of 93.5%; sarcomatoid morphology showed high PPV (92.9%) and NPV (99.3%), and biphasic morphology PPV was 89.7% and NPV was 79.7%. Agreement of the percentage of epithelioid morphology was fair (κ = 0.27). Nuclear grade and necrosis were concordant in 75% (κ = 0.59) and 81% (κ = 0.53) of cases, respectively. Nuclear grade showed moderate (κ = 0.53) and substantial (κ = 0.67) agreement from patients with and without neoadjuvant therapy, respectively, and necrosis showed moderate (κ = 0.47 and κ = 0.60) agreement, respectively, in the same subsets of paired specimens.
Paired biopsy-resection specimens from pleural MM show overall moderate agreement in pathologic parameters. These findings may help guide postbiopsy management and triage of patients with MM.
许多关于恶性间皮瘤（MM）的研究强调了组织学亚型、核分级和坏死的预后重要性。本研究比较了胸膜 MM 的配对活检和切除标本中的这些参数。
比较了 19 个机构的 429 对胸膜 MM 的活检和切除标本中的组织学亚型、上皮样形态的百分比、核分级以及坏死的存在情况。
81%的病例组织学亚型一致（κ=0.58）。与切除标本相比，活检时的上皮样形态具有较高的阳性预测值（PPV）（78.9%）和阴性预测值（NPV）（93.5%）；肉瘤样形态的 PPV 较高（92.9%）和 NPV（99.3%），双相形态的 PPV 为 89.7%，NPV 为 79.7%。上皮样形态百分比的一致性为中等（κ=0.27）。核分级和坏死在 75%（κ=0.59）和 81%（κ=0.53）的病例中一致，分别。核分级在接受和未接受新辅助治疗的患者中分别具有中等（κ=0.53）和显著（κ=0.67）的一致性，坏死在相同的配对标本亚组中分别具有中等（κ=0.47 和 κ=0.60）的一致性。
胸膜 MM 的配对活检-切除标本在病理参数方面总体上具有中等一致性。这些发现可能有助于指导活检后的管理和 MM 患者的分类。
