Cell type accuracy of bronchial biopsy specimens in primary lung cancer

被引:53
作者
Cataluna, JJS [1 ]
Perpina, M [1 ]
Greses, JV [1 ]
Calvo, V [1 ]
Padilla, JD [1 ]
Paris, F [1 ]
机构
[1] HOSP UNIV LA FE,SERV NEUMOL & CIRUGIA TORAC,VALENCIA,SPAIN
关键词
bronchial biopsy; histopathology; lung cancer;
D O I
10.1378/chest.109.5.1199
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objectives: To evaluate the diagnostic accuracy of bronchial biopsy (BE) specimens in establishing the specific cell type in primary lung cancer (LC), and to study the influence of several factors an this accuracy. Setting: Tertiary health-care center. Patients: One hundred forty-six patients with LC diagnosed by BE specimens who underwent thoracotomy (T). Measurements: We have studied the specific LC cell type observed in the BE specimen and compared it with the T specimen (reference diagnosis). Age, location and type of bronchial lesion, number and size of the biopsy fragments, tumoral size, sample necrosis, degree of cell differentiation , tumoral stage, pathologist's experience, and the presence of other diagnostic tests with the same cell type were analyzed to assess their influence on the concordance between the two diagnoses. Results: The overall concordance between BE and T histologic diagnosis was 0.70 (kappa coefficient [K]). Of the different histologic types, the worst result was obtained in large cell carcinoma (LLC) (K, 0.49). Squamous carcinoma and adenocarcinoma gave similar results (0.74 and 0.77, respectively), while small cell lung cancer (SCLC) only reached a value of 0.60. The degree of cell differentiation, the absence of necrosis, and presence of other preoperative diagnoses were the variables that most influenced the histologic accuracy of BB specimens. Therefore, the probability of BB accuracy was 2.7, 7.7, and 25 times higher in cell-differentiated, than in poorly differentiated, moderately differentiated, or undifferentiated carcinomas; 5.2 times higher when there was no necrosis in the sample; and 7.43 higher when there was another preoperative diagnosis. Conclusions: The histologic results of BE must be examined carefully, especially in cellular subtypes like LLC. The absence of differentiation and presence of necrosis in BE samples were the factors that require the greatest caution in ascertaining the cell type. When they are involved and also in all cases in which identifying the specific cell type has important implications, we prefer to classify the patients as having SCLC or non-small cell lung cancer, and then reclassify them later after using a second diagnostic technique.
引用
收藏
页码:1199 / 1203
页数:5
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