Inaccuracy of lung adenocarcinoma subtyping using preoperative biopsy specimens

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 154; no. 1; pp. 332 - 339.e1
• Main Authors: Huang, Kuo-Yang, Ko, Pin-Zuo, Yao, Chih-Wei, Hsu, Cheng-Nan, Fang, Hsin-Yuan, Tu, Chih-Yeh, Chen, Hung-Jen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Adenocarcinoma of Lung - classification; Adenocarcinoma of Lung - diagnostic imaging; Adenocarcinoma of Lung - pathology; Adenocarcinoma of Lung - surgery; Adult; Aged; Aged, 80 and over; Cardiothoracic Surgery; computed tomography–guided 18-gauge core needle biopsy (CTNB); Endosonography; Female; high-grade adenocarcinoma; Humans; Image-Guided Biopsy; lung adenocarcinoma; Male; Middle Aged; Preoperative Care; radial probe endobronchial ultrasound (R-EBUS); Reproducibility of Results; Retrospective Studies; subtype; Tomography, X-Ray Computed; TDR; CI; lung adenocarcinoma; high-grade adenocarcinoma; IQR; GGO; computed tomography–guided 18-gauge core needle biopsy (CTNB); DFS; CT; R-EBUS; subtype; radial probe endobronchial ultrasound (R-EBUS); CTNB; PET; WHO; interquartile range; computed tomography-guided 18-gauge core needle biopsy; computed tomography; World Health Organization; ground glass opacity; disease-free survival; tumor disappearance rate; confidence interval; radial probe endobronchial ultrasound; positron emission tomography
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.02.059

The prognostic significance of the new classification of lung adenocarcinoma proposed in the 2015 World Health Organization guideline has been validated. This study aimed to compare the preoperative classification of the adenocarcinoma subtype based on computed tomography–guided 18-gauge core needle biopsy (CTNB) or radial probe endobronchial ultrasound (R-EBUS) specimens, with the postoperative classification based on the resected specimens. We retrospectively analyzed a consecutive series of 128 patients (60 CTNB and 68 R-EBUS) who underwent surgery for preoperatively confirmed lung adenocarcinoma between 2010 and 2014. Comprehensive histological subtyping was performed according to the 2015 World Health Organization classification system. Diagnostic concordance of subtypes between small biopsy and resection specimens was assessed. Concordant subtyping of adenocarcinomas between the predominant pattern on resections and biopsy sections was observed in 58.6% of cases (75 of 128; 95% confidence interval [CI], 49.9%-66.8%). Preoperative subtyping was accurate in only 30% of samples (3 of 10) with a predominance of solid patterns. None of the 5 micropapillary predominant cases was detected by CTNB or R-EBUS. For the concordance of the presence or absence of micropapillary/solid component, the sensitivity was as low as 16.5% (95% CI, 9.1%-26.5%). The detection rate by CTNB/R-EBUS increased with the increase in the percentage of micropapillary/solid component; however, even in the ≥40% micropapillary/solid group, only 24% of cases were detected by CTNB/R-EBUS. The accuracy of the estimation of adenocarcinoma histological subtype based on preoperative biopsy sections was unsatisfactory.