Liu Dehao, Chen Lichun, Wang Xiaoping, Lin Yikai, Gu Jianwei
Department of Radiology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Radiology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China.
Clin Med Insights Oncol. 2022 Jun 7;16:11795549221102752. doi: 10.1177/11795549221102752. eCollection 2022.
The International Association for the Study of Lung Cancer (IASLC) published a grading system for invasive pulmonary adenocarcinoma that is closely associated with prognosis. This study aimed to investigate the accuracy of computed tomography (CT)-guided biopsy specimen grading and surgery-guided grading systems for detecting invasive non-mucinous lung adenocarcinoma and to determine whether CT-guided biopsy can predict the degree of histological differentiation.
In total, 130 patients with invasive non-mucinous lung adenocarcinoma who underwent CT-guided biopsy before surgical excision were retrospectively studied. Biopsy and surgical specimen pathologies were compared. Grading was performed according to different subtypes proposed by the International Association for the Study of Lung Cancer. Sensitivity, specificity, positive and negative predictive values (PPV/NPV), and accuracy were calculated for each subtype and grade.
The concordance rates of biopsy and surgical pathology subtypes and grades were 73.1% and 72.3%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy of grade 3 were 54.8%, 100%, 100%, 87.6%, and 89.2%, respectively. Pathology grades were primarily discrepant with respect to two aspects of biopsy and surgical samples in the same patient. First, the biopsy and surgical specimen pathology findings indicated lepidic and acinar subtypes as the main subtypes in the same patient, respectively. Second, biopsy specimen histology did not find solid types; however, >20% of solid subtypes were identified in surgical pathology samples in the same patient.
The preoperative CT-guided biopsy specimen grading system showed relatively high accuracy and could predict the prognosis of invasive non-mucinous lung adenocarcinoma.
国际肺癌研究协会（IASLC）发布了一种与预后密切相关的浸润性肺腺癌分级系统。本研究旨在探讨计算机断层扫描（CT）引导下活检标本分级和手术引导下分级系统在检测浸润性非黏液性肺腺癌方面的准确性，并确定CT引导下活检是否能够预测组织学分化程度。
回顾性研究了130例在手术切除前接受CT引导下活检的浸润性非黏液性肺腺癌患者。比较了活检和手术标本的病理情况。根据国际肺癌研究协会提出的不同亚型进行分级。计算了各亚型和分级的敏感性、特异性、阳性和阴性预测值（PPV/NPV）以及准确性。
活检与手术病理亚型及分级的一致率分别为73.1%和72.3%。3级的敏感性、特异性、PPV、NPV和准确性分别为54.8%、100%、100%、87.6%和89.2%。病理分级在同一患者的活检和手术样本的两个方面主要存在差异。首先，活检和手术标本的病理结果分别表明同一患者中以鳞屑状和腺泡状亚型为主要亚型。其次，活检标本组织学未发现实性类型；然而，在同一患者的手术病理样本中发现>20%的实性亚型。
术前CT引导下活检标本分级系统显示出较高的准确性，能够预测浸润性非黏液性肺腺癌的预后。
