Ma Cao, Zhang Lihua
Department of Pathology, Zhongda Hospital, School of Medicine, Southeast Universi, Nanjing, China.
Cytojournal. 2023 Feb 8;20:5. doi: 10.25259/Cytojournal_45_2022. eCollection 2023.
The aims of this study was to investigate the use of cytologic samples for subclassification of lung adenocarcinoma and the cytologic-histologic correlation in lung adenocarcinoma subtypes using small samples.
Cytological characteristics of lung adenocarcinoma subtypes were summarized by a literature review. Cytology samples from 115 patients with lung adenocarcinoma confirmed by small biopsies were classified by subtype. The diagnostic concordance of subtypes between biopsy and cytology samples was assessed.
Among the 115 cases, 62 (53.9%) had acinar predominant pattern, 16 (13.9%) were papillary predominant pattern, 29 (25.2%) had solid predominant pattern, 3 (2.6%) had lepidic predominant pattern, and 5 (4.3%) had micropapillary predominant pattern. All corresponding cytologic samples were classified into five subtypes based on cytomorphology features, with concordance rates of 74.2% (46 patients) in c-acinar subtype, 56.3% (nine patients) in c-papillary subtype, 24.1% (seven patients) in c-solid subtype, 66.7% (two patients) in c-lepidic subtype, and 40% (two patients) in c-micropapillary subtype. Collectively, the cytology and small biopsy concordance rate was approximately 57.4%.
Subtyping of lung adenocarcinoma using cytologic specimens is challenging and the consistency rate varies with the subtype. Acinar predominant tumors have an excellent cytologic-histologic correlation compared to tumors with predominant solid or micropapillary pattern. Evaluating cytomorphologic features of different lung adenocarcinoma subtypes can reduce the false-negative rate of lung adenocarcinoma, particularly for the mild, atypical micropapillary subtype, and improve diagnostic accuracy.
本研究旨在探讨利用细胞学样本对肺腺癌进行亚分类，并使用小样本研究肺腺癌亚型的细胞学-组织学相关性。
通过文献综述总结肺腺癌亚型的细胞学特征。对115例经小活检确诊的肺腺癌患者的细胞学样本进行亚型分类。评估活检样本与细胞学样本之间亚型的诊断一致性。
在115例病例中，62例（53.9%）为腺泡为主型，16例（13.9%）为乳头为主型，29例（25.2%）为实体为主型，3例（2.6%）为鳞屑为主型，5例（4.3%）为微乳头为主型。所有相应的细胞学样本根据细胞形态学特征分为五个亚型，c-腺泡亚型的一致性率为74.2%（46例患者），c-乳头亚型为56.3%（9例患者），c-实体亚型为24.1%（7例患者），c-鳞屑亚型为66.7%（2例患者），c-微乳头亚型为40%（2例患者）。总体而言，细胞学与小活检的一致性率约为57.4%。
使用细胞学标本对肺腺癌进行亚分类具有挑战性，且一致性率因亚型而异。与实体或微乳头为主型肿瘤相比，腺泡为主型肿瘤具有良好的细胞学-组织学相关性。评估不同肺腺癌亚型的细胞形态学特征可降低肺腺癌的假阴性率，尤其是对于轻度、非典型微乳头亚型，并提高诊断准确性。
