Beckert Manuela, Meyer Christian, Papadopoulos Thomas, Levidou Georgia
Department of Pathology, Nuremberg Clinic, Paracelsus Medical University, 90419 Nuremberg, Germany.
Diagnostics (Basel). 2024 Sep 21;14(18):2090. doi: 10.3390/diagnostics14182090.
BACKGROUND/OBJECTIVES: The diagnosis of lung carcinoma (LC) is currently performed in small biopsies and according to the WHO classification by using limited stains to spare tissue for molecular testing. This procedure, however, often causes diagnostic uncertainty among pathologists.
In this retrospective analysis, we compared the diagnosis made by these guidelines in 288 lung biopsies with that using more stains, as retrieved from our archive. We also compared the results of p63 and p40 immunoexpression and investigated the diagnostic role of p53/Rb1.
In our investigation, we reached a definite diagnosis with a mean number of one stain compared with six stains in the original diagnostic procedure, with a 97.3% concordance rate. Only in the case of metastases, a clear advantage is proven in the use of more stains, especially in the absence of clinical information. We also found a comparable utility of p40 and p63 for the diagnosis of squamous cell carcinoma, despite the higher p63 expression in other histological types. Moreover, normal p53/Rb1 expression could be utilized for the exclusion of small-cell LC.
Our study confirms the diagnostic certainty achieved by the suggestions of the WHO classification and justifies the potential insecurity in the absence of adequate communication with the treating clinician.
背景/目的：目前肺癌（LC）的诊断是在小活检标本中进行的，并且根据世界卫生组织（WHO）分类，通过使用有限的染色方法以保留组织用于分子检测。然而，这一过程常常导致病理学家之间的诊断不确定性。
在这项回顾性分析中，我们将这些指南对288例肺活检标本所做出的诊断与从我们的存档中获取的使用更多染色方法所做出的诊断进行了比较。我们还比较了p63和p40免疫表达的结果，并研究了p53/Rb1的诊断作用。
在我们的研究中，平均使用一种染色方法就得出了明确的诊断，而原始诊断程序平均使用六种染色方法，二者的符合率为97.3%。仅在转移瘤的情况下，使用更多染色方法显示出明显优势，尤其是在缺乏临床信息时。我们还发现，尽管在其他组织学类型中p63表达较高，但p40和p63在鳞状细胞癌诊断中的效用相当。此外，正常的p53/Rb1表达可用于排除小细胞肺癌。
我们的研究证实了WHO分类建议所实现的诊断确定性，并说明了在与治疗临床医生缺乏充分沟通的情况下可能存在的不安全性。
