机器人辅助支气管镜检查用于原发性肺腺癌的组织病理学亚型诊断
Robotic-assisted bronchoscopy for histopathologic subtyping of primary lung adenocarcinoma.
作者信息
Kalchiem-Dekel Or, Rakočević Rastko, Toumbacaris Nicolas, Tan Kay See, Nadig Tejaswi R, Adusumilli Prasad S, Dycoco Joseph, Lee Robert P, Oberg Catherine L, Gray Katherine D, Park Bernard J, Rocco Gaetano, Chaft Jaime E, Solomon Stephen B, Jones David R, Chawla Mohit, Husta Bryan C, Baine Marina K, Bott Matthew J
机构信息
Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
出版信息
Lung Cancer. 2025 Jul 28;207:108681. doi: 10.1016/j.lungcan.2025.108681.
BACKGROUND
The identification of high-grade patterns and mucinous features of invasive primary lung adenocarcinoma on biopsy specimens can have implications on therapeutic decisions across all stages of disease. Shape sensing robotic-assisted bronchoscopy (ssRAB) is an emerging modality for the concomitant diagnosis and staging of lung cancer. We evaluated the performance of ssRAB for adenocarcinoma pattern identification, and particularly high-grade patterns, as well as the histopathologic concordance between biopsy and surgical resection specimens.
METHODS
Patients with lung adenocarcinoma diagnosed via ssRAB forceps or cryobiopsy specimens between October 2019 and December 2023 were included in the analysis. Biopsy specimens were evaluated for the identification of histopathologic patterns and mucinous features. A generalized linear mixed model quantified the association between pre- and intra-operative factors and successful pattern identification on biopsy. The concordance between high-grade patterns and mucinous features on ssRAB-acquired biopsy and poorly differentiated grade and mucinous features on subsequent surgical resection was determined.
RESULTS
A total of 242 ssRAB-acquired specimens were included in the final analysis. The biopsy specimen was sufficient to identify adenocarcinoma histopathologic patterns in 71 %. In a multivariable analysis, sampling by cryobiopsy was positively associated with pattern identification (OR 3.54, CI: 1.02-12.30; P = 0.04), as compared with forceps biopsy. A corresponding surgical resection specimen was available in 66 cases. The sensitivity, specificity, positive, and negative predictive values of biopsy were 63, 72, 61, and 74 %, respectively for the presurgical detection of poorly differentiated adenocarcinoma, and 87, 100, 100, and 96 %, respectively for the presurgical detection of mucinous features.
CONCLUSION
This study is the first to report the performance of ssRAB-acquired biopsy for identification of adenocarcinoma patterns and its concordance with surgical resection. Our findings align with those previously reported for percutaneous lung biopsy. ssRAB emerges as a viable tool for the identification of adenocarcinoma patterns. Future studies are needed to confirm these findings in larger patient cohorts.
背景
在活检标本上识别浸润性原发性肺腺癌的高级别模式和黏液特征可能会对疾病各阶段的治疗决策产生影响。形状感知机器人辅助支气管镜检查（ssRAB）是一种用于肺癌同步诊断和分期的新兴技术。我们评估了ssRAB在腺癌模式识别，特别是高级别模式识别方面的性能，以及活检与手术切除标本之间的组织病理学一致性。
方法
分析2019年10月至2023年12月期间通过ssRAB活检钳或冷冻活检标本诊断为肺腺癌的患者。对活检标本进行组织病理学模式和黏液特征的识别评估。广义线性混合模型量化了术前和术中因素与活检时成功模式识别之间的关联。确定了ssRAB获取的活检标本上的高级别模式和黏液特征与后续手术切除时的低分化级别和黏液特征之间的一致性。
结果
最终分析共纳入242个ssRAB获取的标本。71%的活检标本足以识别腺癌组织病理学模式。在多变量分析中，与活检钳活检相比，冷冻活检取样与模式识别呈正相关（OR 3.54，CI：1.02 - 12.30；P = 0.04）。66例患者有相应的手术切除标本。活检对于术前检测低分化腺癌的敏感性、特异性、阳性和阴性预测值分别为63%、72%、61%和74%；对于术前检测黏液特征的敏感性、特异性、阳性和阴性预测值分别为87%、100%、100%和96%。
结论
本研究首次报告了ssRAB获取的活检在腺癌模式识别及其与手术切除一致性方面的性能。我们的研究结果与先前报道的经皮肺活检结果一致。ssRAB成为识别腺癌模式的可行工具。未来需要在更大的患者队列中证实这些发现。
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