Suzuki Mikito, Matsumoto Yuji, Imabayashi Tatsuya, Teishikata Takashi, Tsuchida Takaaki, Asamura Hisao, Yatabe Yasushi
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan; Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Lung Cancer. 2021 Dec;162:147-153. doi: 10.1016/j.lungcan.2021.11.004. Epub 2021 Nov 13.
Micropapillary (MIP) and solid (SOL) subtypes of early-stage lung adenocarcinomas are associated with lymph node metastasis and local recurrence after limited resection. Preoperative identification of these components may influence the decisions of treatment strategy, additional lymph node evaluation, indication for limited resection, and extent of lymph node dissection. However, conventional biopsy specimens are insufficient for identifying these subtypes, especially MIP components. Cryobiopsy can collect larger tissue samples with fewer crush artifacts than conventional forceps biopsy, which would be helpful for detecting MIP/SOL components. Thus, this study aimed to analyze the feasibility of using cryobiopsy for MIP/SOL subtype detection.
Consecutive patients who underwent surgery for clinical IA lung cancer following a preoperative diagnosis of adenocarcinoma by cryobiopsy at our institution between October 2017 and July 2019 were retrospectively examined. The concordance rate of MIP/SOL subtypes between the specimens obtained by cryobiopsy and surgery was investigated.
In total, 115 patients were evaluated. There were 26 (22.6%) and 14 (12.2%) patients with MIP and SOL subtypes, respectively. For concordance of MIP/SOL subtypes, the sensitivity was 65.7% (95% confidence interval [CI]: 57.7-65.7%). For the primary or secondary predominant patterns, a more satisfactory concordance rate of 72.2% (95% CI: 52.6-86.2%) was obtained. On assessing each subtype, high sensitivity was noted in SOL-predominant patterns (85.7%, 95% CI: 56.5%-96.0%) and MIP-secondary predominant patterns (83.3%, 95% CI: 45.8-97.0%). However, SOL-secondary predominant patterns revealed low sensitivity (0%, 95% CI, 0-38.2%). Overall, the MIP subtypes had higher sensitivity than the SOL subtypes (65.4% vs. 50.0%).
Cryobiopsy could be reliable for identifying MIP/SOL components, especially the MIP component, in clinical stage IA adenocarcinomas.
早期肺腺癌的微乳头（MIP）和实体（SOL）亚型与有限切除术后的淋巴结转移及局部复发相关。术前识别这些成分可能会影响治疗策略的决策、额外的淋巴结评估、有限切除的指征以及淋巴结清扫范围。然而，传统活检标本不足以识别这些亚型，尤其是MIP成分。冷冻活检能够收集比传统钳取活检更大的组织样本，且挤压伪像更少，这将有助于检测MIP/SOL成分。因此，本研究旨在分析使用冷冻活检检测MIP/SOL亚型的可行性。
对2017年10月至2019年7月期间在本机构通过冷冻活检术前诊断为腺癌并接受临床IA期肺癌手术的连续患者进行回顾性研究。研究冷冻活检和手术获取的标本之间MIP/SOL亚型的符合率。
总共评估了115例患者。分别有26例（22.6%）和14例（12.2%）患者为MIP和SOL亚型。对于MIP/SOL亚型的符合情况，敏感性为65.7%（95%置信区间[CI]：57.7 - 65.7%）。对于主要或次要的优势模式，获得了更令人满意的符合率，为72.2%（95% CI：52.6 - 86.2%）。在评估每种亚型时，在SOL优势模式（85.7%，95% CI：56.5% - 96.0%）和MIP次要优势模式（83.3%，95% CI：45.8 - 97.0%）中观察到高敏感性。然而，SOL次要优势模式显示出低敏感性（0%，95% CI，0 - 38.2%）。总体而言，MIP亚型比SOL亚型具有更高的敏感性（65.4%对50.0%）。
冷冻活检在识别临床IA期腺癌的MIP/SOL成分，尤其是MIP成分方面可能是可靠的。
