Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases.
Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases.
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DOI：
10.1097/pas.0b013e3181b8cf03
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发表时间：
2009-12
期刊：
影响因子：
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通讯作者：
Travis WD
中科院分区：
文献类型：
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作者：
Girard N;Deshpande C;Lau C;Finley D;Rusch V;Pao W;Travis WD
非小细胞肺癌（NSCLC）的病理分类正在演变。肺腺癌的形态是异质性的，在80%以上的病例中混合有腺泡、乳头状、细支气管肺泡和实性模式。在同时性或异时性多发性NSCLC的情况下，肺内转移与独立原发性肿瘤的区别具有重要的临床意义，因为它影响分期和潜在的治疗策略。在这里，我们利用了一个队列的20例患者的42个多发性NSCLC肿瘤（24个潜在的配对比较），使用基因组和突变谱进行分子注释，以评估在这种情况下，全面的组织学评估的价值。使用Martini-Melamed标准，配对肿瘤在21例中被表征为多原发性NSCLC，在3例中被表征为肺内转移。基因组和突变数据导致14例患者诊断为多原发灶，8例患者诊断为转移灶; 2例患者无法评估。在22个可评估的比较中，有7个（32%）的分子特征与Martini-Melamed诊断相矛盾。腺癌32例（76%）。在盲法检查后，16例配对肿瘤的半定量综合组织学评估不同，8例配对肿瘤的半定量综合组织学评估相似。我们发现比较腺癌是一个复杂的问题，不仅需要评估组织学亚型的百分比，而且还需要记录其他组织学细节，如细胞学特征，间质模式，坏死，离散结节与粟粒生长和变异，如透明细胞，印戒，粘液和胎儿模式。我们还发现配对鳞状细胞癌除了细胞学和间质特征外，还可以根据组织学亚型进行比较。考虑到组织学上不同的肿瘤为多原发灶，相似的肿瘤为转移灶，22对比较中有20对（91%）的综合组织学亚型与分子特征一致。总之，基于一个具有详细临床、病理和分子数据的良好特征的队列，我们发现全面的组织学评估是一种强有力的工具，似乎是一种有前途的方法来确定多发性肺腺癌或鳞状细胞癌是转移性的还是多发性的。这对肺癌多肿瘤患者的分期和治疗管理具有重要的临床意义。鉴于其与此类肿瘤的分子特征的高度相关性，它可能提供一种更便宜，更快速的方法来解决这个问题
The pathological classification of non-small cell lung cancer (NSCLC) is evolving. Lung adenocarcinoma is morphologically heterogeneous, with mixtures of acinar, papillary, bronchioloalveolar and solid patterns in more than 80% of cases. In case of synchronous or metachronous multiple NSCLC, the distinction of intrapulmonary metastases from independent primary tumors is of great clinical importance since it influences staging and potentially the therapeutic strategy. Here we took advantage of a cohort of 20 patients with 42 multiple NSCLC tumors (24 potential pair comparisons) that were annotated molecularly using genomic and mutational profiling to evaluate the value of comprehensive histologic assessment in this setting. Using the Martini-Melamed criteria, paired tumors were characterized as multiple primary NSCLCs in 21 cases and as intra-pulmonary metastases in 3 cases. Genomic and mutational data led to a diagnosis of multiple primaries in 14 cases and of metastases in 8 cases; 2 cases could not be assessed. This molecular characterization contradicted the Martini-Melamed diagnosis in 7 (32%) of the 22 assessable comparisons. Adenocarcinoma was found in 32 (76%) of the 42 tumors. After review in a blinded fashion, semiquantitative comprehensive histologic assessement of paired tumors was different in 16 and similar in 8 paired tumors. We found that comparing adenocarcinomas is a complex issue that requires assessment not only of percentages of the histologic subtypes, but also the recording of additional histologic details such as cytologic features, patterns of stroma, necrosis, discrete nodularity versus miliary growth and variants such as clear cell, signet ring, mucinous, and fetal patterns. We also found that paired squamous cell carcinomas could be compared based on histologic subtyping in addition to cytologic and stromal characteristics. Considering histologically different tumors as multiple primaries, and similar tumors as metastases, comprehensive histologic subtyping was consistent with the molecular characterization in 20 (91%) of the 22 pairs comparisons. In summary, based on a well characterized cohort with detailed clinical, pathologic and molecular data, we found comprehensive histologic assessment is a powerful tool that appears to be a promising way to determine whether multiple lung adenocarcinomas or squamous cell carcinomas are metastatic or multiple primaries. This has great clinical implications for staging and therapeutic management of lung cancer patients with multiple tumors. Given its high correlation with molecular characterization of such tumors, it may provide a much cheaper and faster method to address this problem