The effect that pathologic and radiologic interpretation of invasive and non-invasive areas in lung adenocarcinoma has on T-stage and treatment
The effect that pathologic and radiologic interpretation of invasive and non-invasive areas in lung adenocarcinoma has on T-stage and treatment
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DOI：
10.1016/j.anndiagpath.2021.151799
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发表时间：
2021-07-23
影响因子：
2
通讯作者：
Garcia-Moliner, Maria
中科院分区：
文献类型：
--
作者：
Hart, Jesse L.;Canepa, Mariana;Garcia-Moliner, Maria
肺腺癌目前是根据浸润性肿瘤的大小进行分期的，不包括鳞片状（原位）生长的区域。侵袭性肿瘤的大小可以通过手术标本的病理评估或计算机断层扫描（CT）的放射学评估来确定。当浸润性肿瘤的大小是决定肿瘤分期的主要因素时，放射学-病理学不一致或病理学家之间的不一致解释可能会改变肿瘤分期和治疗。我们回顾了40例非粘液性肺腺癌，其中肿瘤大小是唯一的分期决定因素。我们确定了观察者之间的差异时，显微镜下评估建筑模式及其对病理分期和治疗的影响。此外，我们将病理学和影像学评估浸润性肿瘤的大小及其对肿瘤分期和治疗的影响相关联。三位病理学家之间的组内相关性为0.9879;所有三位病理学家在75%的病例中同意T分期。4例病理学不一致病例有可能改变治疗。病理学家和CT扫描确定的浸润性肿瘤大小之间的组内相关性为0.8482。23例（57.5%）病理T分期与临床T分期（CT扫描确定）不同（增加>90%的时间）。5例影像学-病理学不一致病例导致分期改变，可能改变辅助治疗。我们的研究结果表明，病理分期的阶段差异具有病理学相关性，但不太可能影响辅助治疗的常规选择，并且当浸润性肿瘤大小是主要的分期决定因素时，观察到的临床分期差异倾向于选择过度使用新辅助治疗。
Lung adenocarcinoma is currently staged based on invasive tumor size, excluding areas of lepidic (in situ) growth. Invasive tumor size may be determined by pathologic assessment of a surgical specimen or radiographic assessment on computerized tomography (CT) scan. When invasive tumor size is the primary stage determinate, radiographic-pathologic discordance or discordant interpretation among pathologists may alter tumor stage and treatment. We reviewed 40 cases of non-mucinous pulmonary adenocarcinoma in which tumor size was the only stagedeterminant. We determined the inter-observer variability when microscopically assessing architectural patterns and its effect on pathologic stage and treatment. Additionally, we correlated pathologic and radiographic assessment of invasive tumor size and its effect on tumor stage and treatment. The intraclass correlation among three pathologists was 0.9879; all three pathologists agreed on T-stage in 75% of cases. Four cases of pathologic disagreement had the potential to alter therapy. Intraclass correlation between the pathologists and invasive tumor size determined by CT scan was 0.8482. In 23 cases (57.5%) the pathologic T-stage differed (it increased >90% of the time) from clinical T-stage (determined by CT scan) based on invasive tumor size. Five of the radiographically-pathologically discrepant cases resulted in a stage change that had the potential to alter adjuvant therapy. Our findings suggest the stage differences in pathologic staging are prognostically relevant, but unlikely to impact routine selection of adjuvant therapy, and the observed variability in clinical stage tends to select against overuse of neoadjuvant therapy when invasive tumor size is the primary stage-determinant.