Factors Influencing the Diagnostic Accuracy of Identifying the Histologic Type of Non-Small-Lung Cancer With Small Samples
Factors Influencing the Diagnostic Accuracy of Identifying the Histologic Type of Non-Small-Lung Cancer With Small Samples
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DOI：
10.1016/j.cllc.2015.03.007
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发表时间：
2015-09-01
影响因子：
3.6
通讯作者：
Ikeda, Norihiko
中科院分区：
文献类型：
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作者：
Oikawa, Takefumi;Ohira, Tatsuo;Ikeda, Norihiko
组织学类型的病理诊断对于肺癌治疗方案的决策至关重要。然而，较小的组织样本存在较大的误诊风险。我们发现非小细胞肺癌肿瘤分化程度和肿瘤直径与术前经支气管镜检查结果的诊断准确性相关。背景：病理诊断已成为肺癌治疗方案决策中更多的考虑因素。因此，即使只有少量活检或细胞学样本，肿瘤组织学类型的准确诊断也至关重要。然而，活检样本越小，误诊的风险就越大。小样本误诊风险增加的因素尚不清楚。本研究的目的是确定影响通过支气管镜检查获得的小活检和细胞学肺样本的病理诊断准确性的临床和病理因素（免疫组织化学染色除外）。患者和方法：我们对 299 例手术切除的肺癌标本中的 126 例进行了经支气管肺活检或刷洗和灌洗以确定术前诊断。我们评估了术前经支气管镜检查结果与手术切除肺标本的诊断准确性。结果：单变量分析显示，非对应病例的平均病理肿瘤大小大于对应病例。在不对应的病例中，血管侵犯也更为普遍。非对应病例的肿瘤分化程度低于对应病例。不对应的病例处于较进展阶段。多变量分析显示，病理肿瘤大小和肿瘤分化等级与不对应病例相关。结论：我们发现较大的肿瘤尺寸和较差的分化程度表明肺癌组织中异质细胞含量较多。因此，仅使用这些因素存在误诊断的可能性。因此，应考虑病理诊断和其他相关因素来做出治疗决定。
The pathologic diagnosis of the histologic type is critical to decision-making regarding the treatment options for lung cancer. However, a greater risk of misdiagnosis exists with smaller tissue samples. We found that the nonesmall-cell lung cancer tumor differentiation grade and tumor diameter were associated with the diagnostic accuracy of the preoperative transbronchoscopic examination findings.Background: The pathologic diagnosis has become a greater consideration in decision-making regarding the treatment options for lung cancer. Therefore, the accurate diagnosis of the tumor histologic type is essential, even when only small biopsy or cytology samples are available. However, the risk of a misdiagnosis with smaller biopsy samples is greater. The factors underlying the increased risk of a misdiagnosis in small samples are unknown. The aim of the present study was to identify the clinical and pathologic factors (other than immunohistochemical staining) that influence the pathologic diagnostic accuracy in small biopsy and cytological lung samples obtained by bronchoscopy. Patients and Methods: We performed transbronchial lung biopsy or brushing and lavage to determine the preoperative diagnosis of 126 of 299 surgically resected lung cancer specimens. We assessed the diagnostic accuracy of the preoperative transbronchoscopic examination findings against that of the surgically resected lung specimens. Results: On univariate analysis, the mean pathologic tumor size in the noncorresponding cases was larger than that in corresponding cases. Vascular invasion was also more prevalent in the noncorresponding cases. The tumor differentiation grade in the noncorresponding cases was poorer than in the corresponding cases. The noncorresponding cases were at a more progressed stage. On multivariate analysis, the pathologic tumor size and tumor differentiation grade were associated with the noncorresponding cases. Conclusion: We found a larger tumor size and poor differentiation grade were indicative of lung cancer tissue with a greater content of heterogeneous cells. Therefore, a possibility exists of a false diagnosis using only these factors. Thus, treatment decisions should be made considering the pathologic diagnosis and other relevant factors.