Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Mod Pathol. 2023 Sep;36(9):100209. doi: 10.1016/j.modpat.2023.100209. Epub 2023 May 4.
A novel histologic grading system for invasive lung adenocarcinomas (LUAD) has been newly proposed and adopted by the World Health Organization (WHO) classification. We aimed to evaluate the concordance of newly established grades between preoperative biopsy and surgically resected LUAD samples. Additionally, factors affecting the concordance rate and its prognostic impact were also analyzed. In this study, surgically resected specimens of 222 patients with invasive LUAD and their preoperative biopsies collected between January 2013 and December 2020 were used. We determined the histologic subtypes of preoperative biopsy and surgically resected specimens and classified them separately according to the novel WHO grading system. The overall concordance rate of the novel WHO grades between preoperative biopsy and surgically resected samples was 81.5%, which was higher than that of the predominant subtype. When stratified by grades, the concordance rate of grades 1 (well-differentiated, 84.2%) and 3 (poorly differentiated, 89.1%) was found to be superior compared to grade 2 (moderately differentiated, 66.2%). Overall, the concordance rate was not significantly different from biopsy characteristics, including the number of biopsy samples, biopsy sample size, and tumor area size. On the other hand, the concordance rate of grades 1 and 2 was significantly higher in tumors with smaller invasive diameters, and that of grade 3 was significantly higher in tumors with larger invasive diameters. Preoperative biopsy specimens can predict the novel WHO grades, especially grades 1 and 3 of surgically resected specimens, more accurately than the former grading system, regardless of preoperative biopsy or clinicopathologic characteristics.
一种新的肺浸润性腺癌（LUAD）组织学分级系统已由世界卫生组织（WHO）分类系统提出并采用。我们旨在评估术前活检和手术切除 LUAD 样本之间新建立的分级的一致性。此外，还分析了影响一致性率的因素及其预后影响。在这项研究中，使用了 222 例浸润性 LUAD 患者的手术切除标本及其在 2013 年 1 月至 2020 年 12 月期间采集的术前活检。我们确定了术前活检和手术切除标本的组织学亚型，并根据新的 WHO 分级系统分别对其进行分类。术前活检和手术切除标本之间新的 WHO 分级的总体一致性率为 81.5%，高于主要亚型的一致性率。按分级分层时，发现 1 级（高分化，84.2%）和 3 级（低分化，89.1%）的一致性率优于 2 级（中分化，66.2%）。总体而言，一致性率与活检特征（包括活检样本数量、活检样本大小和肿瘤面积大小）无显著差异。另一方面，在侵袭性直径较小的肿瘤中，1 级和 2 级的一致性率明显更高，而在侵袭性直径较大的肿瘤中，3 级的一致性率明显更高。术前活检标本可以预测新的 WHO 分级，特别是手术切除标本的 1 级和 3 级，比前一个分级系统更准确，而与术前活检或临床病理特征无关。
