浅表基底细胞癌，想得更深入些：皮肤活检标本的分步切片可增加 14%的侵袭性亚型。

Superficial basal cell carcinoma, think deeper: Step sectioning of skin biopsy specimens yields 14% more aggressive subtypes.

机构信息

Department of Dermatology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.

Department of Pathology, University Medical Center Utrecht, University Utrecht, University Utrecht, Utrecht, The Netherlands.

出版信息

PLoS One. 2022 Jan 20;17(1):e0256149. doi: 10.1371/journal.pone.0256149. eCollection 2022.

DOI:10.1371/journal.pone.0256149

PMID:35051169

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8775292/

Abstract

INTRODUCTION

Because of different therapeutic regimens for superficial and non-superficial basal cell carcinomas (BCCs), accurate histopathological examination of a punch biopsy to determine its subtype is essential. The aim of the current study was to evaluate the additional yield of a more extensive step-section method to that of a standard histologic examination at 4 levels.

MATERIAL AND METHODS

Data for this prospective study was obtained from the Pathology department of a Dutch tertiary hospital. Biopsy specimens of subsequent patients from March 2019 to June 2020 were sectioned to 8-levels instead of the regular 4-levels. Only patients with a superficial BCC subtype in the first 4-levels of sectioning were included (n = 100). After 8-level sectioning, it was recorded in which level (5-8) a more aggressive BCC component was found (i.e. nodular, infiltrative, or micronodular). Patients were followed-up to evaluate further treatment, and in case of excision, the excision specimen was reviewed to determine the BCC subtype. A logistic regression was performed to assess characteristics associated with a more aggressive BCC component in levels 5-8.

RESULTS

In 14 patients (14%) a more aggressive component was found in levels 5-8, all with a nodular component. Thirteen of these patients underwent excision, confirming a more aggressive BCC subtype. Of the 86 patients that had no deeper BCC component in levels 5-8, 26 (30.2%) underwent excision; In 4 patients no residual BCC was found, in 15 patients superficial BCC, and in 7 a more aggressive BCC subtype (1 nodular and 6 a combination of superficial/nodular/infiltrative). In multivariable analysis, head&neck localization was associated with finding a more aggressive BCC subtype in levels 5-8 (OR 6.41 (95%CI 1.56-26.30), p = 0.01)).

CONCLUSIONS

More extensive sectioning of superficial BCC biopsy specimens, especially in the head&neck area, leads to a more accurate BCC subtype diagnosis requiring different clinical management strategies.

摘要

简介

由于表浅性和非表浅性基底细胞癌（BCC）的治疗方案不同，因此准确的组织病理学检查以确定其亚型至关重要。本研究的目的是评估更广泛的分步切片法与常规的 4 级切片法相比，在确定 BCC 亚型方面的额外收益。

材料与方法

本前瞻性研究的数据来自荷兰一家三级医院的病理学部门。2019 年 3 月至 2020 年 6 月期间，对随后的患者的活检标本进行 8 级切片，而不是常规的 4 级切片。仅纳入初次 4 级切片为表浅 BCC 亚型的患者（n=100）。8 级切片后，记录在哪个水平（5-8 级）发现了侵袭性更高的 BCC 成分（即结节状、浸润性或微结节状）。对患者进行随访以评估进一步的治疗方法，在进行切除的情况下，会对切除标本进行复查以确定 BCC 亚型。采用逻辑回归分析评估与 5-8 级中侵袭性更高的 BCC 成分相关的特征。

结果

在 14 名患者（14%）的 5-8 级中发现了侵袭性更高的成分，均为结节状成分。其中 13 名患者接受了切除手术，证实了侵袭性更高的 BCC 亚型。在 5-8 级无深部 BCC 成分的 86 名患者中，26 名（30.2%）进行了切除；4 名患者未发现残留的 BCC，15 名患者为表浅性 BCC，7 名患者为侵袭性更高的 BCC 亚型（1 名结节状和 6 名表浅/结节状/浸润性混合）。多变量分析显示，头颈部定位与 5-8 级中发现侵袭性更高的 BCC 亚型相关（OR 6.41（95%CI 1.56-26.30），p=0.01））。