Subtyping of Non-small Cell Lung Carcinoma: A Comparison of Small Biopsy and Cytology Specimens

摘要: Background There is growing evidence that lung adenocarcinoma and squamous cell carcinoma (SQCC) have distinct oncogenic mutations divergent therapeutic responses, which driving the heightened emphasis on accurate pathologic subtyping of non-small (NSCLC). The relative feasibility accuracy NSCLC by small biopsy versus cytology not well established, particularly in current practice where immunohistochemistry (IHC) becoming routinely used to aid this distinction. Methods Concurrent specimens obtained during a single procedure diagnosed as 2-year period ( n = 101) were reviewed. Concordance diagnoses two methods was assessed. Accuracy determined based subsequent resection or autopsy diagnosis 21) IHC for thyroid transcription factor 1 p63 subset cases 43). Results distribution definitive favored unclassified categories (reflecting degree diagnostic certainty) similar (71% 23% 6%, respectively) (69% 19% 12%, respectively), p 0.29. When results from paired combined, rate at least one method increased 84% decreased 4%. subtype concordance between 93%. Kappa coefficient (95% confidence interval) agreement 0.88 (0.60–0.89) 0.76 (0.63–0.89) SQCC. In pairs with discordant 7) correct tumor type identified frequency 4) 3). Factors contributing mistyping poor differentiation, necrosis, low cellularity, lack supporting IHC. All concordant verification available 57) correct. more frequently than (32% 6%; 0.0001). Conclusions Small achieve comparable rates subtyping, optimal are attained when modalities considered jointly. lower requirement highlights strength cytomorphology subtyping. Whenever clinically feasible, obtaining parallel encouraged.