Adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive pulmonary adenocarcinoma-analysis of interobserver agreement, survival, radiographic characteristics, and gross pathology in 296 nodules
Adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive pulmonary adenocarcinoma-analysis of interobserver agreement, survival, radiographic characteristics, and gross pathology in 296 nodules
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DOI：
10.1016/j.humpath.2015.12.010
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发表时间：
2016-05-01
期刊：
影响因子：
3.3
通讯作者：
Yi, Eunhee S.
中科院分区：
文献类型：
--
作者：
Boland, Jennifer M.;Froemming, Adam T.;Yi, Eunhee S.
国际肺癌研究协会/美国胸科学会/欧洲呼吸学会和2015年世界卫生组织肺腺癌分类推荐将完全呈鳞状生长的肿瘤命名为原位腺癌（AIS），将浸润小于或等于5mm的鳞状肿瘤命名为微创腺癌（MIA），两者的预后都优于传统的浸润性腺癌（IA）。该分类中观察者间可变性的数据有限，需要进一步验证AIS和MIA的高生存率。我们回顾了254例（1997-2009）手术切除的296例肺腺癌。切片由2名肺病理学家独立审查，他们将肿瘤分类为AIS、MIA或IA。在296例结节中，有244例（82.4%）得到了双方的一致意见：AIS 10例，MIA 61例，IA 173例（kappa = 0.63，一致性良好）。6例（2%）AIS与MIA不一致；MIA与IA不一致45例（15%）；在1个案例中，AIS和IA之间存在分歧。两组观察人员确定的总生存率在不同类别之间有显著差异。MIA和IA不一致的病例生存率与同意MIA相似。AIS的疾病特异性10年生存率为100%（两名观察者），MIA为97.3%和97.6%，尽管与IA相比，两名观察者的疾病特异性10年生存率均未达到统计学意义。在将肿瘤分类为AIS、MIA和IA时，观察者之间存在良好的一致性。两组观察者的总生存率均有显著差异，观察者之间的差异也很明显。AIS和MIA患者均有良好的DSS。(C) 2016 Elsevier Inc.版权所有。
The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society and 2015 World Health Organization classifications of lung adenocarcinoma recommend designating tumors showing entirely lepidic growth as adenocarcinoma in situ (AIS) and lepidic tumors with invasion less than or equal to 5 mm as minimally invasive adenocarcinoma (MIA), both of which have superior outcome to conventional invasive adenocarcinoma (IA). Data on interobserver variability within this classification are limited, and further validation of the superior survival of AIS and MIA is needed. A total of 296 surgically excised pulmonary adenocarcinomas were reviewed from 254 patients (1997-2009). Slides were independently reviewed by 2 pulmonary pathologists who categorized tumors as AIS, MIA, or IA. Of 296 nodules, 244 (82.4%) were agreed upon by both observers: 10 AIS, 61 MIA, and 173 IA (kappa = 0.63, good agreement). In 6 cases (2%), there was disagreement between AIS and MIA; in 45 cases (15%), there was disagreement between MIA and IA; and in 1 case, there was disagreement between AIS and IA. Overall survival was significantly different among categories as determined by both observers. Cases with disagreement between MIA and IA had similar survival to agreed MIA. Disease-specific 10-year survival was 100% for AIS (both observers) and 97.3% and 97.6% for MIA, although this did not reach statistical significance compared to IA for either observer. Good agreement was present between observers when classifying tumors as AIS, MIA, and IA. Significant differences in overall survival were present between the 3 groups for both observers, and interobserver variability was evident. Patients with AIS and MIA experienced excellent DSS. (C) 2016 Elsevier Inc. All rights reserved.