Reiko Matsuzawa1, Keisuke Kirita2, Takeshi Kuwata3, Shigeki Umemura2, Shingo Matsumoto2, Satoshi Fujii3, Kiyotaka Yoh2, Motohiro Kojima3, Seiji Niho2, Hironobu Ohmatsu2, Atsushi Ochiai3, Masahiro Tsuboi4, Koichi Goto2, Genichiro Ishii5. 1. Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Japan; Department of Thoracic Oncology, National Cancer Center Hospital East, Japan. 2. Department of Thoracic Oncology, National Cancer Center Hospital East, Japan. 3. Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Japan. 4. Department of Thoracic Surgery, National Cancer Center Hospital East, Japan. 5. Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Japan. Electronic address: gishii@east.ncc.go.jp.
Abstract
OBJECTIVES: Lung adenocarcinoma is heterogeneous, characterized by various histological subtypes. Determination of the predominant histological subtype (lepidic, papillary, acinar or solid-predominant) has been shown to correlate with genetic abnormalities and clinicopathological features. Although subtyping using small biopsy samples is important for tailored approaches to clinical management, limited data exist on the concordance of predominant subtype between resected specimens and biopsy specimens. MATERIALS AND METHODS: We compared the diagnosed predominant subtypes in resected specimens and matched biopsy specimens in a series of 327 lung adenocarcinomas. The accuracy of preoperative diagnosis by biopsy and the factors that influence concordance with resected specimen analysis were examined. RESULTS: In 211 of the 326 patients (66.0%), the predominant adenocarcinoma subtype diagnosed from biopsy matched the findings of resection analysis. Overall, the concordance rate in biopsy samples with larger tumor areas (≥ 0.7 mm(2)) was significantly higher than in those with smaller tumor area (<0.7 mm(2); 71.2% vs 60.7%, respectively; p=0.015). In the biopsy samples with smaller tumor areas, the concordance rate was 77% in lepidic subtype, 71% in papillary subtype, 60% in solid subtype, and 40% in acinar subtype. Concordance rate in the biopsy samples with larger tumor area was higher in papillary and solid subtypes (88% and 76%, respectively), but remained low in acinar subtype (37%). CONCLUSION: The current results indicate that accuracy of adenocarcinoma subtyping based on small biopsy samples is influenced by tumor area. Our study also suggests that subtyping of acinar histology using biopsy specimen is particularly error-prone.
OBJECTIVES:Lung adenocarcinoma is heterogeneous, characterized by various histological subtypes. Determination of the predominant histological subtype (lepidic, papillary, acinar or solid-predominant) has been shown to correlate with genetic abnormalities and clinicopathological features. Although subtyping using small biopsy samples is important for tailored approaches to clinical management, limited data exist on the concordance of predominant subtype between resected specimens and biopsy specimens. MATERIALS AND METHODS: We compared the diagnosed predominant subtypes in resected specimens and matched biopsy specimens in a series of 327 lung adenocarcinomas. The accuracy of preoperative diagnosis by biopsy and the factors that influence concordance with resected specimen analysis were examined. RESULTS: In 211 of the 326 patients (66.0%), the predominant adenocarcinoma subtype diagnosed from biopsy matched the findings of resection analysis. Overall, the concordance rate in biopsy samples with larger tumor areas (≥ 0.7 mm(2)) was significantly higher than in those with smaller tumor area (<0.7 mm(2); 71.2% vs 60.7%, respectively; p=0.015). In the biopsy samples with smaller tumor areas, the concordance rate was 77% in lepidic subtype, 71% in papillary subtype, 60% in solid subtype, and 40% in acinar subtype. Concordance rate in the biopsy samples with larger tumor area was higher in papillary and solid subtypes (88% and 76%, respectively), but remained low in acinar subtype (37%). CONCLUSION: The current results indicate that accuracy of adenocarcinoma subtyping based on small biopsy samples is influenced by tumor area. Our study also suggests that subtyping of acinar histology using biopsy specimen is particularly error-prone.
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