支气管肺类癌（BPC）诊断中的病理及放射学变量，重点关注抗原Kiel 67（Ki-67）增殖指数。

Pathological & radiological variables in the diagnosis of bronchopulmonary carcinoids (BPCs) with a focus on Antigen Kiel 67 (Ki-67) proliferation index.

作者信息

Ahuja Gaurav, Iyer Aparna, Harwood Rachel, Balata Haval, Craig Christopher, Crosbie Philip A J, Hewitt Kath, Peplow Karen, Hutchings Deborah, Sharman Anna, Bishop Paul, Joseph Leena, Paiva-Correia Antonio, Chaturvedi Anshuman, Barr James, Leek Angela, Backen Alison, Nuttall Christina, Kennedy Oliver, Williamson Andrew, Weaver Jamie, Mansoor Wasat, Evison Matthew

机构信息

Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland.

出版信息

Lung Cancer. 2025 Apr;202:108493. doi: 10.1016/j.lungcan.2025.108493. Epub 2025 Mar 10.

DOI:10.1016/j.lungcan.2025.108493

PMID:40101668

Abstract

BACKGROUND

Bronchopulmonary carcinoids (BPCs) are classified into typical carcinoids (TC) and atypical carcinoids (AC), based on the mitotic count and absence/presence of necrosis on pathology specimens. There are limitations to accurate measurement of these criteria. It important to study other markers like Ki-67, to enhance the diagnostic accuracy of lung carcinoids.

OBJECTIVE AND METHODOLOGY

Retrospective analysis of BPCs treated with surgery between 2012-2022, to examine the accuracy of Ki-67 on the diagnostic specimen, concordance of diagnostic and resection specimens, diagnostic accuracy of Positron Emission Tomography (PET) and concordance of clinical and pathological staging.

RESULTS

205 patients were included in the analysis (final diagnosis TC 180, AC 25). Mean age 60.5 years and 68 % female. Ki-67 (<5% vs. 5-30 %) on diagnostic biopsy, available in 64 % (n = 131) of the cohort, had specificity (diagnose TC correctly) of 89.4 % (95 %CI 80.4 %-94.7 %) and sensitivity (diagnose AC correctly) of 77.8 % (40.2 %-96.1 %). This compared to 97.5 % (90.3 %-99.6 %) and 36.4 % (12.4 %-68.4 %) for mitotic count (<2mitoses/2mm vs. 2-10mitoses/2mm) and 100 % (94.4 %-100 %) and 21.4 % (5.7 %-51.2 %) for necrosis (absence vs. presence). A pre-resection diagnosis of TC (including surgical biopsy) shows better concordance with final diagnosis on resection specimen (94.9 %, 95 %CI 88.7 %-97.9 %, n = 117) as compared to the diagnosis of AC 83.3 % (95 %CI 50.9 %-97.1 %, n = 12). Concordance for AC appears higher with image guided lung biopsy 80 % (95 % CI, 29.9 %-98.9 %) than bronchoscopy 50 % (9.5 %-90.5 %). SUVmax on 18FDG-PET was a modest predictor of BPC sub-type with an AUC of 0.684 (95 % CI: 0.545,0.823). The clinical and pathological staging were concordant in 46 % (85/184) cases. However, 27 % (50/184) were upstaged and 13 % (23/172) found to have occult nodal metastases on pathology review of the surgical specimens.

CONCLUSION

The diagnosis and sub-typing of BPCs on diagnostic specimens is challenging. Our data suggest Ki-67 could increase diagnostic accuracy, but further research is needed to confirm this.

摘要

背景

支气管肺类癌（BPC）根据病理标本中的有丝分裂计数和有无坏死分为典型类癌（TC）和非典型类癌（AC）。准确测量这些标准存在局限性。研究其他标志物如Ki-67以提高肺类癌的诊断准确性很重要。

目的和方法

回顾性分析2012年至2022年间接受手术治疗的BPC，以检查诊断标本中Ki-67的准确性、诊断标本与切除标本的一致性、正电子发射断层扫描（PET）的诊断准确性以及临床和病理分期的一致性。

结果

205例患者纳入分析（最终诊断为TC 180例，AC 25例）。平均年龄60.5岁，68例为男性。队列中64%（n = 131）的患者有诊断性活检的Ki-67结果（<5% 与5 - 30%），其特异性（正确诊断TC）为89.4%（95%CI 80.4% - 94.7%），敏感性（正确诊断AC）为77.8%（40.2% - 96.1%）。相比之下，有丝分裂计数（<2个有丝分裂/2mm与2 - 10个有丝分裂/2mm）的特异性为97.5%（90.3% - 99.6%），敏感性为36.4%（12.4% - 68.4%）；坏死（无与有）的特异性为100%（94.4% - 100%），敏感性为21.4%（5.7% - 51.2%）。与AC的诊断（83.3%，95%CI 50.9% - 97.1%，n = 12）相比，术前TC诊断（包括手术活检）与切除标本的最终诊断一致性更好（94.9%，95%CI 88.7% - 97.9%，n = 117）。AC通过影像引导肺活检的一致性（80%，95%CI，29.9% - 98.9%）高于支气管镜检查（50%，9.5% - 90.5%）。18FDG - PET上的SUVmax对BPC亚型的预测能力一般，曲线下面积为0.684（95%CI：0.545，0.823）。临床和病理分期在46%（85/184）的病例中一致。然而，27%（50/184）的病例分期上调，13%（23/172）在手术标本的病理复查中发现有隐匿性淋巴结转移。