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Choi W, Liu CJ, Alam SR, Oh JH, Vaghjiani R, Humm J, Weber W, Adusumilli PS, Deasy JO, Lu W. Preoperative 18F-FDG PET/CT and CT radiomics for identifying aggressive histopathological subtypes in early stage lung adenocarcinoma. Comput Struct Biotechnol J 2023; 21:5601-5608. [PMID: 38034400 PMCID: PMC10681940 DOI: 10.1016/j.csbj.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Lung adenocarcinoma (ADC) is the most common non-small cell lung cancer. Surgical resection is the primary treatment for early-stage lung ADC while lung-sparing surgery is an alternative for non-aggressive cases. Identifying histopathologic subtypes before surgery helps determine the optimal surgical approach. Predominantly solid or micropapillary (MIP) subtypes are aggressive and associated with a higher likelihood of recurrence and metastasis and lower survival rates. This study aims to non-invasively identify these aggressive subtypes using preoperative 18F-FDG PET/CT and diagnostic CT radiomics analysis. We retrospectively studied 119 patients with stage I lung ADC and tumors ≤ 2 cm, where 23 had aggressive subtypes (18 solid and 5 MIPs). Out of 214 radiomic features from the PET/CT and CT scans and 14 clinical parameters, 78 significant features (3 CT and 75 PET features) were identified through univariate analysis and hierarchical clustering with minimized feature collinearity. A combination of Support Vector Machine classifier and Least Absolute Shrinkage and Selection Operator built predictive models. Ten iterations of 10-fold cross-validation (10 ×10-fold CV) evaluated the model. A pair of texture feature (PET GLCM Correlation) and shape feature (CT Sphericity) emerged as the best predictor. The radiomics model significantly outperformed the conventional predictor SUVmax (accuracy: 83.5% vs. 74.7%, p = 9e-9) and identified aggressive subtypes by evaluating FDG uptake in the tumor and tumor shape. It also demonstrated a high negative predictive value of 95.6% compared to SUVmax (88.2%, p = 2e-10). The proposed radiomics approach could reduce unnecessary extensive surgeries for non-aggressive subtype patients, improving surgical decision-making for early-stage lung ADC patients.
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Affiliation(s)
- Wookjin Choi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Chia-Ju Liu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sadegh Riyahi Alam
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Raj Vaghjiani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wolfgang Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Prasad S. Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Ma C, Zhang L. Comparison of small biopsy and cytology specimens: Subtyping of pulmonary adenocarcinoma. Cytojournal 2023; 20:5. [PMID: 36895259 PMCID: PMC9990844 DOI: 10.25259/cytojournal_45_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 02/09/2023] Open
Abstract
Objectives The aims of this study was to investigate the use of cytologic samples for subclassification of lung adenocarcinoma and the cytologic-histologic correlation in lung adenocarcinoma subtypes using small samples. Methods and Methods Cytological characteristics of lung adenocarcinoma subtypes were summarized by a literature review. Cytology samples from 115 patients with lung adenocarcinoma confirmed by small biopsies were classified by subtype. The diagnostic concordance of subtypes between biopsy and cytology samples was assessed. Results Among the 115 cases, 62 (53.9%) had acinar predominant pattern, 16 (13.9%) were papillary predominant pattern, 29 (25.2%) had solid predominant pattern, 3 (2.6%) had lepidic predominant pattern, and 5 (4.3%) had micropapillary predominant pattern. All corresponding cytologic samples were classified into five subtypes based on cytomorphology features, with concordance rates of 74.2% (46 patients) in c-acinar subtype, 56.3% (nine patients) in c-papillary subtype, 24.1% (seven patients) in c-solid subtype, 66.7% (two patients) in c-lepidic subtype, and 40% (two patients) in c-micropapillary subtype. Collectively, the cytology and small biopsy concordance rate was approximately 57.4%. Conclusion Subtyping of lung adenocarcinoma using cytologic specimens is challenging and the consistency rate varies with the subtype. Acinar predominant tumors have an excellent cytologic-histologic correlation compared to tumors with predominant solid or micropapillary pattern. Evaluating cytomorphologic features of different lung adenocarcinoma subtypes can reduce the false-negative rate of lung adenocarcinoma, particularly for the mild, atypical micropapillary subtype, and improve diagnostic accuracy.
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Affiliation(s)
- Cao Ma
- Department of Pathology, Zhongda Hospital, School of Medicine, Southeast Universi, Nanjing, China
| | - Lihua Zhang
- Department of Pathology, Zhongda Hospital, School of Medicine, Southeast Universi, Nanjing, China
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Boler AK, Bandyopadhyay A, Bandyopadhyay A, Roy S, Roy B. Appreciation of Pattern in Diagnosis of Lung Adenocarcinoma from Cytology Specimen: Our Experience with Fine Needle Aspiration Cytology and Cell Block in a Resource Constraint Setup. J Cytol 2020; 37:141-146. [PMID: 33088033 PMCID: PMC7542038 DOI: 10.4103/joc.joc_148_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/26/2020] [Accepted: 05/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND AIMS Advent of personalised treatment needs correct diagnosis of lung adenocarcinoma with its molecular subtyping. Minimal use of special stain or immunohistochemistry (IHC) in small specimens save material for molecular testing. Various histologic patterns in adenocarcinoma (ADC) subtypes have different prognostic implications and current recommendation is to describe these patterns in small specimens. Aim of this study was to diagnose adenocarcinoma from cytology specimens depending on adenocarcinoma pattern on fine needle aspiration smears and cell blocks. We also studied the additional role of cell blocks as a platform for special stain and IHC. MATERIALS AND METHODS Conventional smears and cell block (CB) preparation were examined from transthoracic CT guided FNA samples of suspicious lung malignancy cases. Clear defining architectural pattern and cytomorphological features in favour of adenocarcinoma were evaluated and mucin stain and IHC were used as and when required. RESULTS A total of 86 cases were included in this study, of which 83 cases were diagnosed as adenocarcinoma, 52 (62.5%) showed clear cut evidence of adenocarcinoma from smears and CBs. CB morphology alone aided the diagnosis in 12. Various ADC patterns in combination or alone were appreciated in these 64 cases. Sixteen needed mucin stain and 3 needed IHC for diagnosis. Forty one were ADC with solid pattern of which 39 showed high nuclear grade. CONCLUSION Adequately cellular FNA smears and corresponding cell blocks of optimal quality can aid effectively in diagnosing adenocarcinoma and appreciating its pattern. Therefore, it would minimize the need for special stain and/or IHC with preservation of more material for molecular testing.
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Affiliation(s)
- Anup Kumar Boler
- Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Arghya Bandyopadhyay
- Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Abhishek Bandyopadhyay
- Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Shreosee Roy
- Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Banani Roy
- Department of Biochemistry, Raiganj Medical College and Hospital, Uttar Dinajpur, West Bengal, India
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Boggio F, Del Gobbo A, Croci G, Barella M, Ferrero S. Early stage lung cancer: pathologist's perspective. J Thorac Dis 2020; 12:3343-3348. [PMID: 32642258 PMCID: PMC7330767 DOI: 10.21037/jtd.2019.12.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Francesca Boggio
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Croci
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Barella
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Nambirajan A, Kaur H, Jangra K, Kaur K, Madan K, Mathur SR, Iyer VK, Jain D. Adenocarcinoma predominant pattern subtyping and nuclear grading in cytology: Is there a role in prognostication of advanced pulmonary adenocarcinomas? Cytopathology 2018; 29:163-171. [DOI: 10.1111/cyt.12519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
Affiliation(s)
- A. Nambirajan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - H. Kaur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Jangra
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Kaur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Madan
- Department of Pulmonary Medicine; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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Isaka T, Yokose T, Miyagi Y, Washimi K, Nishii T, Ito H, Nakayama H, Yamada K, Masuda M. Detection of tumor spread through airspaces by airway secretion cytology from resected lung cancer specimens. Pathol Int 2017; 67:487-494. [PMID: 28857359 DOI: 10.1111/pin.12570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
It currently remains unclear whether tumor spread through airspaces (STAS) actually exist in vivo or are an artifact. The morphologies of STAS and tumor cell clusters in airway secretions collected from the segmental or lobar bronchus of resected lung adenocarcinomas and squamous cell carcinomas were compared among 48 patients. The EGFR status of tumor cell clusters in airway secretions was also compared with that of the main tumor in EGFR mutant adenocarcinomas. Tumor cell clusters were observed in the airway secretion cytology of ten patients (20.8%), and eight patients were adenocarcinoma (20.0% of adenocarcinoma). The morphology of STAS closely resembled that of tumor cell clusters detected in airway secretion cytology. The positive rates of airway secretion cytology were 83.3%, 100%, and 50% in papillary adenocarcinoma, micropapillary adenocarcinoma, and invasive mucinous adenocarcinoma, respectively. Among three EGFR mutant adenocarcinomas, the EGFR mutation subtypes of the main tumors in FFPE sections and tumor cell clusters in airway secretions were identical. These indicate that STAS may be detected in the airway secretion cytology. STAS is common in papillary or micropapillary adenocarcinoma and may spread as far as the segmental or lobar bronchus at the time of surgery.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Teppei Nishii
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
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7
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Miyata K, Morita S, Dejima H, Seki N, Matsutani N, Mieno M, Kondo F, Soejima Y, Tanaka F, Sawabe M. Cytological markers for predicting ALK-positive pulmonary adenocarcinoma. Diagn Cytopathol 2017; 45:963-970. [PMID: 28834601 DOI: 10.1002/dc.23800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND ALK gene rearrangement is an important class of gene mutations in pulmonary adenocarcinoma. ALK-positive pulmonary adenocarcinoma exhibits characteristic histological features, such as signet ring cell carcinoma (SRCC) and a mucinous cribriform structure. However, when insufficient histological specimens are obtained, ALK-positivity must be predicted based on cytological features. The purpose of this study was to clarify the cytological characteristics of ALK-positive pulmonary adenocarcinoma. METHODS We compared the cytological findings of 16 ALK-positive cases with 40 ALK-negative cases. We examined various cytoplasmic features of SRCC, including the presence of pink, yellow, or orange mucin; green, vacuolar, or vesicular cytoplasm; and green globular cytoplasmic secretions. We also examined whether the SRCC cells exhibited a pattern of individually scattered cells, the formation of cell clusters, and formation of a mucinous cribriform pattern. RESULTS A univariate analysis showed that significantly frequent cytological findings included pink mucin, green cytoplasm, vacuolar cytoplasm, vesicular cytoplasm, green globular cytoplasmic secretions, an individually scattered pattern, cluster formation, and a mucinous cribriform structure (all, P < .05). A stepwise multivariate logistic regression analysis identified three significant contributing factors: pink mucin (P = .03), vesicular cytoplasm (P = .06), and an individually scattered pattern (P = .01) of SRCC. If the specimens showed two or three of these features, the sensitivity and specificity were both 88% for the prediction of ALK-positive cancers. CONCLUSION Three cytological features of SRCC (pink mucin, vesicular cytoplasm, and an individually scattered pattern) could be useful cytological markers for the prediction of ALK-positive pulmonary adenocarcinoma.
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Affiliation(s)
- K Miyata
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan.,Department of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Morita
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan.,Department of Pathology, Tokyo University Hospital, Tokyo, Japan
| | - H Dejima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - N Seki
- Department of Medical Oncology, Teikyo University Hospital, Tokyo, Japan
| | - N Matsutani
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - M Mieno
- Center for Information, Jichi Medical University, Tochigi, Japan
| | - F Kondo
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan
| | - Y Soejima
- Department of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - F Tanaka
- Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - M Sawabe
- Department of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Dong Z, Li H, Zhou J, Zhang W, Wu C. The value of cell block based on fine needle aspiration for lung cancer diagnosis. J Thorac Dis 2017; 9:2375-2382. [PMID: 28932542 DOI: 10.21037/jtd.2017.07.91] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous lung fine needle aspiration (FNA) is a convenient method to obtain samples from pulmonary lesions. FNA has a lower rate of complications than the use of a core needle biopsy, but is more difficult for the diagnosis of cytological samples. We use cell block (CB) and immunocytochemistry (ICC) to improve the accuracy of cytological diagnoses based on CT-guided percutaneous lung FNA. METHODS We collected 526 cytological samples obtained using CT-guided percutaneous lung FNA at Shanghai Pulmonary Hospital from May 2015 to October 2015. CBs were created from these samples, and ICC was performed to help the further histological classification and confirmation of tumor as primary or metastatic. An automated Ventana ALK with clone D5F3 was used to identify ALK fusion protein. RESULTS After assessment of the CBs, 32 (6.08%) diagnoses of suspected malignancy were reduced to 10 (1.90%) such diagnoses (P<0.05), and 161 (30.61%) cases of non-small-cell lung carcinoma (NSCLC) were reduced to 33 (6.27%) cases (P<0.05) after their division into specific subtypes. We also diagnosed eight (1.52%, P<0.05) cases of metastatic carcinoma of the lung that were difficult to diagnose by cytological smear alone. Six (3.73%) of 161 NSCLC cases exhibited ALK rearrangement. CONCLUSIONS CB and ICC are useful for accurate cytological diagnosis using CT-guided percutaneous lung FNA. These approaches are valuable for providing individualized treatment and prognostic evaluations with minor complications.
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Affiliation(s)
- Zhengwei Dong
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hui Li
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jun Zhou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Wei Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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9
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Borczuk AC. Prognostic considerations of the new World Health Organization classification of lung adenocarcinoma. Eur Respir Rev 2017; 25:364-371. [PMID: 27903658 DOI: 10.1183/16000617.0089-2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/23/2016] [Indexed: 01/19/2023] Open
Abstract
The 2015 World Health Organization (WHO) lung adenocarcinoma classification divides tumours into categories of indolent pre-invasive, minimally invasive and predominantly lepidic and, by examining predominant patterns of invasion, allows for further stratification into intermediate and high-grade tumours. The impact of the 2015 classification on prognosis was reviewed by a PubMed search for search terms "adenocarcinoma", "lung pathology" and "prognosis" and relevant publications reviewed. These were sorted for data on stage and survival as impacted by histological classification, and survival studies were separated into all stage versus stage 1 studies. Predictive aspects of histological classification were also examined, but molecular correlates were not. The separation of adenocarcinoma in situ and minimally invasive adenocarcinoma from invasive subtypes as distinct prognostic entities and the prognostic significance, for disease specific and overall survival for low- and high-grade categories, are discussed. The impact on stage at presentation including risk of node metastasis by histology is examined, as well as histology in relation to recurrence after surgery. Early data with regard to the value of predominant histology in the prediction of chemotherapy response will also be explored.
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10
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Rodriguez EF, Monaco SE. Recent advances in the pathology and molecular genetics of lung cancer: A practical review for cytopathologists. J Am Soc Cytopathol 2016; 5:252-265. [PMID: 31042502 DOI: 10.1016/j.jasc.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Abstract
Lung cancer is one of the most common causes of cancer-related death worldwide. Better understanding of the molecular genetic characteristics of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma, has opened the opportunity for targeted therapies. With the different molecular abnormalities and the different responses to new targeted therapies based on the histological subtype of NSCLC, there came a need to further classify NSCLC into squamous cell carcinoma and adenocarcinoma, and to perform the appropriate molecular testing in these different subtypes to guide management decisions. Given that approximately 70% of lung cancer patients have only small biopsies or cytology specimens available, incorporating the testing of these specimens into the cytopathology laboratory has been crucial. Herein, we review current concepts and recommendations on NSCLC subtyping and molecular testing that are relevant for the cytopathology community.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University, Carnegie 469-Pathology, 600 North Wolfe Street, Baltimore, Maryland.
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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11
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Cao Y, Zhu LZ, Jiang MJ, Yuan Y. Clinical impacts of a micropapillary pattern in lung adenocarcinoma: a review. Onco Targets Ther 2015; 9:149-58. [PMID: 26770064 PMCID: PMC4706128 DOI: 10.2147/ott.s94747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lung adenocarcinoma with a micropapillary pattern (MPPAC) has recently drawn increased attention among researchers. Micropapillary-predominant adenocarcinoma (MPA), which is defined by micropapillary pattern (MPP), is the primary histological pattern observed semiquantitatively in 5% increments on resection specimens, and MPA was formally determined to be a new histological subtype according to the new multidisciplinary classification in 2011. According to published studies, MPPAC is most common in males and nonsmokers and is associated with lymphatic invasion, pleural invasion, and lymph node metastases. MPPAC often presents as part-solid and lobulated nodules in computed tomography scans. MPP tends to have a higher maximum standardized uptake value as determined by fluorodeoxyglucose positron emission tomography combined with computed tomography, indicating a high risk of recurrence. Molecular markers, including vimentin, napsin A, phosphorylated c-Met, cytoplasmic maspin, Notch-1, MUC1, and tumoral CD10, may have higher expression in MPPAC than other subtypes; conversely, markers such as MUC4 and surfactant apoprotein A have lower expression in MPPAC. MPPAC with EGFR mutations can benefit from treatment with EGFR tyrosine kinase inhibitors. Furthermore, a complete lobectomy may be more suitable than limited resection for MPPAC because of the low sensitivity of intraoperative frozen sections and the high risk of lymph node metastasis. MPA benefits more from adjuvant chemotherapy than do other histological subtypes, whereas MPA does not benefit from adjuvant radiotherapy. Of note, MPP is associated with poor prognosis in early-stage lung adenocarcinoma, but the prognostic value of MPP is controversial in advanced-stage lung adenocarcinoma.
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Affiliation(s)
- Ying Cao
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Li-Zhen Zhu
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Meng-Jie Jiang
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ying Yuan
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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12
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Zhao S, Guo T, Li J, Uramoto H, Guan H, Deng W, Gu C. Expression and prognostic value of GalNAc-T3 in patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma after IASLC/ATS/ERS classification. Onco Targets Ther 2015; 8:3143-52. [PMID: 26604783 PMCID: PMC4629976 DOI: 10.2147/ott.s93486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background GalNAc-T3 catalyzes initial glycosylation of mucin-type O-linked protein involved in proliferation, adhesion, and migration of tumor cells. This study was performed to explore the relationships of the expression of GalNAc-T3 in small peripheral lung adenocarcinoma, especially as an indicator of prognosis. Materials and methods A retrospective analysis of the patients with small peripheral lung lesions, including 106 adenocarcinoma and two precancerous lesions (atypical adenomatous hyperplasia and adenocarcinoma in situ) after complete surgical resection, was launched. Expression of GalNAc-T3 was examined using immunohistochemistry staining on primary tumor specimens, and the tumors were reclassified in light of the IASLC/ATS/ERS (International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society) adenocarcinoma classifications followed by grading and scoring. Moreover, reverse transcription polymerase chain reaction and Western blot were used to study the expression of GalNAc-T3 in vivo. Results The low expression of GalNAc-T3 was found in the cytoplasm of tumor cells in 56 of 108 patients (51.9%) and was associated with IASLC/ATS/ERS classification of high risk groups (P=0.007), high Sica score (P=0.036), poorly differentiated tumor (P=0.023), poor tumor-node-metastasis (TNM) stage (P=0.007), pleural invasion (P=0.007), and vascular invasion (P<0.001) by Pearson’s chi-squared test, but not with sex, age, smoking status, concentration of carcinoembryonic antigen, and lymph node metastasis. In logistic regression analysis, low GalNAc-T3 expression was only correlated with high-ranking TNM stage (odds ratio [OR] =8.975, 95% confidence interval [CI]: 1.797–44.661), vascular invasion (OR =5.668, 95% CI: 1.827–17.578), and the higher risk grade (low risk grade: OR =0.141, 95% CI: 0.027–0.719; moderate risk grade: OR =0.122, 95% CI: 0.017–40.871). The low expression of the GalNAc-T3 usually in adenocarcinoma cell lines was compared with normal bronchial epithelium cell line. Based on the univariate and multivariate analysis, poor TNM stage (P<0.001), pleural invasion (hazard ratio [HR]: 7.958, P=0.021), vascular invasion (HR: 2.403, P=0.040), and low GalNAc-T3 expression (HR: 3.317, P=0.016) were shown to be independently associated with an unfavorable prognosis. However, IASLC/ATS/ERS classification of risk groups and Sica score (P=0.034 and P=0.032, respectively) was correlated with overall survival on Kaplan–Meier method but not Cox regression model. Conclusion GalNAc-T3 expression was correlated with the IASLC/ATS/ERS classification and also associated with prognosis of patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma.
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Affiliation(s)
- Shilei Zhao
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Tao Guo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Jinxiu Li
- Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
| | - Hongwei Guan
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Wuguo Deng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Chundong Gu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
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13
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Rodriguez EF, Dacic S, Pantanowitz L, Khalbuss WE, Monaco SE. Cytopathology of pulmonary adenocarcinoma with a single histological pattern using the proposed International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification. Cancer Cytopathol 2015; 123:306-17. [DOI: 10.1002/cncy.21532] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/12/2015] [Accepted: 01/20/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Erika F. Rodriguez
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Sanja Dacic
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Walid E. Khalbuss
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Sara E. Monaco
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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14
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Pareja F, Crapanzano JP, Mansukhani MM, Bulman WA, Saqi A. Cytomorphological features ofALK-positive lung adenocarcinomas: Psammoma bodies and signet ring cells. Cancer Cytopathol 2014; 123:162-70. [DOI: 10.1002/cncy.21507] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/22/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Fresia Pareja
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - John P. Crapanzano
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - William A. Bulman
- Department of Medicine; Columbia University Medical Center; New York New York
| | - Anjali Saqi
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
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15
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Lee MC, Kadota K, Buitrago D, Jones DR, Adusumilli PS. Implementing the new IASLC/ATS/ERS classification of lung adenocarcinomas: results from international and Chinese cohorts. J Thorac Dis 2014; 6:S568-80. [PMID: 25349708 DOI: 10.3978/j.issn.2072-1439.2014.09.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/26/2014] [Indexed: 12/13/2022]
Abstract
A new histologic classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) in 2011 to provide uniform terminology and diagnostic criteria for multidisciplinary strategic management. This classification proposed a comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) and a semi-quantitative assessment of histologic patterns (in 5% increments) in an effort to choose a single, predominant pattern in invasive adenocarcinomas. The prognostic value of this classification has been validated in large, independent cohorts from multiple countries. In patients who underwent curative-intent surgery, those with either an adenocarcinoma in situ (AIS) or a minimal invasive adenocarcinoma have nearly 100% disease-free survival and are designated "low grade tumors". For invasive adenocarcinomas, the acinar and papillary predominant histologic subtypes were usually designated as "intermediate grade" while the solid and micropapillary predominant histologic subtypes were designated "high grade" tumors; this was based on the statistic difference of overall survival. This classification, coupled with additional prognostic factors [nuclear grade, cribriform pattern, high Ki-67 labeling index, thyroid transcription factor-1 (TTF-1) immunohistochemistry, immune markers, and (18)F-fluorodeoxyglucose uptake on positron emission tomography (PET)] that we have published on, could further stratify patients into prognostic subgroups and may prove helpful for individual patient care. With regard to Chinese oncologists, the implementation of this new classification only requires hematoxylin and eosin (H&E) stained slides and basic pathologic training, both of which require no additional costs. More importantly, this new classification system could provide informative data for better selection and stratification of clinical trials and molecular studies.
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Affiliation(s)
- Ming-Ching Lee
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Kyuichi Kadota
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Daniel Buitrago
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - David R Jones
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Prasad S Adusumilli
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
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16
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Lee MC, Buitrago DH, Kadota K, Jones DR, Adusumilli PS. Recent advances and clinical implications of the micropapillary histological subtype in lung adenocarcinomas. Lung Cancer Manag 2014; 3:245-253. [PMID: 25202339 DOI: 10.2217/lmt.14.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Micropapillary (MIP) histologic subtype included in the classification of lung adenocarcinomas (ADCs) is associated with both size- and stage-independent poor prognoses. MIP pattern in lung ADCs, even at small, early stages, correlates with high lymphovascular invasion, visceral pleural invasion and lymph node metastases. Recently, we reported that patients with a MIP component are at a higher risk of locoregional recurrence after limited resection. Identification of a MIP pattern is only possible with permanent pathologic sections; preoperative imaging, cytology or intraoperative frozen section specimens remain unreliable. The intermixed, heterogenous morphology of lung ADC presents a technical challenge in investigating the molecular biology of cells with MIP morphology. A comprehensive understanding of the biology of MIP morphology is vital for therapeutic interventions.
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Affiliation(s)
- Ming-Ching Lee
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA ; Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan (ROC)
| | - Daniel H Buitrago
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kyuichi Kadota
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA ; Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA ; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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17
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Huq GE, Canberk S, Oznur M, Yildiz P, Bahadir B, Behzatoğlu K. Cytological features of pure micropapillary carcinoma of various organs: A report of eight cases. Oncol Lett 2014; 8:705-710. [PMID: 25013488 PMCID: PMC4081296 DOI: 10.3892/ol.2014.2198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/13/2014] [Indexed: 11/27/2022] Open
Abstract
Micropapillary carcinoma (MPC) is a rare aggressive tumor, which generally accompanies the primary carcinoma of the organ of its origin, while the pure form is extremely uncommon. Angiolymphatic involvement is widespread and a considerable proportion of the cases present with metastases. The current study presents eight pure MPC cases arising from the breast (n=3), urinary bladder (n=3), parotid gland (n=1) and lung (n=1, presenting with pericardial effusion), with the cytological findings. The eight patients included three female and five male cases aged between 48 and 74 years. The most common cytological findings were three-dimensional aggregates, cell clusters with angulated or scalloped borders, single cells with a columnar configuration and eccentric nuclei, and high-grade nuclear features. Histopathological sections showed accompanying in situ ductal carcinoma in the cases of MPC arising in the parotid gland and breast (n=3), and one case in the bladder exhibited only in situ MPC. The average follow-up period was 20 months (range, 6–54 months) and, during this period, three patients succumbed to the disease. At present, four patients are alive with disease and one patient is alive and disease-free. In conclusion, cytology is an important tool for the diagnosis and management of MPC.
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Affiliation(s)
- Gülben Erdem Huq
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul 34098, Turkey
| | - Sule Canberk
- Department of Pathology, Istanbul University, Cerrahpasa Medical Faculty Istanbul 34320, Turkey
| | - Meltem Oznur
- Department of Pathology, Namık Kemal University Medical Faculty, Tekirdağ 59100, Turkey
| | - Pelin Yildiz
- Department of Pathology, Bezmialem University, Medical Faculty, Istanbul 34093, Turkey
| | - Burak Bahadir
- Department of Pathology, Bülent Ecevit University, Zonguldak 67100, Turkey
| | - Kemal Behzatoğlu
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul 34098, Turkey
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18
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Chang NY, Wang J, Lin CC, Chen SW. Cytodiagnostic aspects of lung adenocarcinoma manifesting with micropapillary pattern in sputum: a case report of potential diagnostic pitfall. Diagn Cytopathol 2014; 42:902-5. [PMID: 24554565 DOI: 10.1002/dc.23104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/20/2013] [Accepted: 01/09/2014] [Indexed: 11/11/2022]
Abstract
The micropapillary pattern of lung adenocarcinoma was discussed in the 2004 World Health Organization classification and is now proposed as a distinct pattern in the new International Multidisciplinary Classification of Lung Adenocarcinoma Guidelines. The micropapillary pattern is histologically characterized by papillary tufts lacking a central fibrovascular core and is associated with an unfavorable prognosis. Herein, we report the cytological features of lung adenocarcinoma with the micropapillary pattern in a sputum specimen. A 75-year-old woman presented with a productive cough, blood-tinged sputum, and some symptoms of upper respiratory tract infection. The initial impressions from her chest radiograph and computed tomography scan indicated pneumonia. However, the initial sputum cytology sample showed a few clusters of cells with abnormal three-dimensional structure, interpreted as adenocarcinoma. These cells were small and had minimal cytologic atypia, demonstrating a potential diagnostic pitfall. The following biopsy confirmed lung adenocarcinoma with the micropapillary pattern. Here, we describe this case and discuss the differential diagnosis of pulmonary entities exhibiting similar morphologies.
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Affiliation(s)
- Nien-Yi Chang
- Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Pathology, Da Chien General Hospital, Miaoli, Taiwan
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19
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Rodriguez EF, Monaco SE, Dacic S. Cytologic subtyping of lung adenocarcinoma by using the proposed International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) adenocarcinoma classification. Cancer Cytopathol 2013; 121:629-37. [DOI: 10.1002/cncy.21314] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 02/23/2013] [Accepted: 03/11/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Erika F. Rodriguez
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Sara E. Monaco
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Sanja Dacic
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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20
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Moreira AL. Subtyping of pulmonary adenocarcinoma in cytologic specimens. Cancer Cytopathol 2013; 121:601-4. [DOI: 10.1002/cncy.21313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Andre L. Moreira
- Department of Pathology; Memorial Sloan-Kettering Cancer Center; New York New York
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21
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Sigel CS, Rudomina DE, Sima CS, Rekhtman N, Travis WD, Geisinger KR, Moreira AL. Predicting pulmonary adenocarcinoma outcome based on a cytology grading system. Cancer Cytopathol 2011; 120:35-43. [DOI: 10.1002/cncy.20185] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Hasanovic A, Rekhtman N, Sigel CS, Moreira AL. Advances in fine needle aspiration cytology for the diagnosis of pulmonary carcinoma. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:897292. [PMID: 21776344 PMCID: PMC3137976 DOI: 10.4061/2011/897292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 05/03/2011] [Indexed: 12/14/2022]
Abstract
New developments in the field of thoracic oncology have challenged the way pathologists approach the diagnosis of pulmonary carcinoma. Nonsmall cell carcinoma is no longer an adequate diagnostic category. Pathologists are required to further classify tumors into adenocarcinoma and squamous cell carcinoma since specific therapies are now recommended depending on the histological tumor type. This change occurred following the discovery of specific molecular alterations that predict response to certain drugs and now molecular testing of tumor cells is often requested to direct therapy. The vast majority of lung cancer is diagnosed in advanced clinical stages, where cytologic or small biopsy material is the only form of tissue diagnosis, thus placing cytology, especially fine needle aspiration biopsy in the front line for management of patients with lung cancer. In this paper we will review the current concepts in the suitability and accuracy of fine needle aspiration biopsy, including diagnosis, classification, prognostic markers, and use of ancillary techniques.
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Affiliation(s)
- Adnan Hasanovic
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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23
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A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stage I tumors. Am J Surg Pathol 2010; 34:1155-62. [PMID: 20551825 DOI: 10.1097/pas.0b013e3181e4ee32] [Citation(s) in RCA: 270] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently no objective grading system for pulmonary adenocarcinomas exists. To determine whether specific histologic patterns or combinations thereof could be linked to an objective grading system, the histologic patterns in metastatic tumor deposits was compared with the patterns seen in the corresponding 73 primary tumor to determine whether a specific pattern had higher propensity to metastasize. The concordance of the predominant histologic pattern in the primary tumor and the metastases was of 100% for micropapillary, 86% for solid, 42% for acinar, and 23% for papillary types of adenocarcinoma. Informed by these results, a 3-tier grading system based on the histologic subtypes was established. Grade I, a pattern with low metastatic potential (BAC); Grade II, patterns with intermediate metastatic potential (acinar and papillary); and Grade III, patterns with high metastatic potential (solid and micropapillary). These grades were combined into a number of different scoring systems, whose ability to predict recurrence or death from disease was tested in 366 stage 1 adenocarcinomas. A score based on the 2 most predominant grades was able to stratify patients into low-to-high risk for recurrence or death of disease (P=0.001). The 5-years disease-free survival for patients in the highest score group was of 0.73, compared with 0.84 and 0.92 in the intermediate and lowest score groups. Concordance probability estimate was 0.65 (95% confidence interval 0.57-0.73). Therefore, this scoring system provides valuable information in discriminating patients with different risk of disease-recurrence in a highly homogeneous population of patients with stage I cancer.
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