痰和支气管细胞学中早期（T1）肺癌和细支气管腺癌的检测。

Detection of early (T1) lung cancers and lepidic adenocarcinomas in sputum and bronchial cytology.

机构信息

Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.

出版信息

Ann Diagn Pathol. 2023 Dec;67:152191. doi: 10.1016/j.anndiagpath.2023.152191. Epub 2023 Aug 10.

DOI:10.1016/j.anndiagpath.2023.152191

PMID:37579536

Abstract

BACKGROUND

The lung is an extensively epithelialized organ, producing ample exfoliated material for sputum and bronchial cytology. In view of the updates in the World Health Organization classification of early (T1/≤ 3 cm) lung cancer with respect to adenocarcinomas with lepidic pattern, this study retrospectively reviews sputum and bronchial cytology paired with resection-confirmed lung cancers.

METHODS

A computerized search for all lung resection specimens of carcinomas over a 20-year period was performed. Cytologic diagnoses of corresponding sputum and bronchial cytology were classified into five-tiered categories (C1-insufficient/inadequate, C2-benign, C3-atypia, C4-suspicious and C5-malignant). Reports and slides of the resection specimen were reviewed for reclassification of T1 cancers.

RESULTS

Totally 472 and 383 sputum and bronchial cytology specimens respectively were included. Sensitivity for T1 lesions on sputum cytology were 10.6 %, 2.1 % and 0.5 % at cutoffs of atypia/C3, suspicious/C4 and malignant/C5 categories, lower than bronchial cytology (35.1 %, 15.5 %, 8.1 %; p < 0.001). T1 lesions correlated with lower detection rates, whereas squamous cell carcinoma histology, larger size and bronchial invasion were associated with increased detection rates in sputum and bronchial cytology (p < 0.050). Detection rates for abrasive bronchial cytology (brushing) were overall higher (p = 0.018- < 0.001), but on subgroup comparison, non-abrasive (aspiration, lavage and washing) cytology demonstrated favorable trends (p = 0.063-0.088) in detecting T1 lesions. Adenocarcinomas with lepidic pattern had lower suspicious/C4 (p = 0.040) or above and malignant/C5 (p = 0.019), but not atypia/C3 or above (p = 0.517) rates.

CONCLUSIONS

Most adenocarcinomas with lepidic pattern are only diagnosed as atypia/C3 on cytology. With its modest sensitivity, interpretation of negative and indeterminate cytology results mandates caution.

摘要

背景

肺是一个广泛上皮化的器官，产生大量可用于痰和支气管细胞学检查的脱落物。鉴于世界卫生组织（WHO）早期（T1/≤3cm）肺癌分类中对具有贴壁样生长模式的腺癌的更新，本研究回顾性分析了与经手术证实的肺癌配对的痰和支气管细胞学检查。

方法

对 20 年来所有肺癌切除术标本进行了计算机检索。将相应的痰和支气管细胞学检查的细胞学诊断分为五个等级（C1-不足/不充分，C2-良性，C3-非典型，C4-可疑，C5-恶性）。对切除标本的报告和切片进行重新分类，以确定 T1 癌。

结果

共纳入 472 例痰细胞学检查和 383 例支气管细胞学检查标本。在 C3（非典型）、C4（可疑）和 C5（恶性）的分类截断值时，痰细胞学检查对 T1 病变的敏感性分别为 10.6%、2.1%和 0.5%，低于支气管细胞学检查（35.1%、15.5%和 8.1%；p<0.001）。T1 病变的检出率较低，而鳞状细胞癌组织学、较大的肿瘤大小和支气管侵犯与痰和支气管细胞学检查的检出率增加有关（p<0.050）。磨碎式支气管细胞学检查（刷检）的总体检出率较高（p=0.018-<0.001），但在亚组比较中，非磨碎式（抽吸、灌洗和洗涤）细胞学检查在检测 T1 病变方面显示出有利的趋势（p=0.063-0.088）。贴壁样生长模式的腺癌具有较低的 C4（可疑）或以上和 C5（恶性）的检出率（p=0.040 和 0.019），但 C3（非典型）或以上的检出率无差异（p=0.517）。