An Accurate Diagnosis of Noguchi Classification Is Possible after the Modification of Preoperative Biopsy-Induced Fibrosis

• Published in: Annals of thoracic and cardiovascular surgery Vol. 15; no. 4; pp. 221 - 226
• Main Authors: Nakajima, Yuki, Kawamoto, Masashi, Koizumi, Kiyoshi, Tajima, Hiroyuki, Fukuda, Yuh, Tsuchiya, Shin-Ichi, Shimizu, Kazuo
• Format: Journal Article
• Language: English
• Published: Japan 01.08.2009
• Subjects: Adenocarcinoma, Bronchiolo-Alveolar - pathology; Adenocarcinoma, Bronchiolo-Alveolar - surgery; Adult; Aged; Aged, 80 and over; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; bronchioloalveolar carcinoma; Case-Control Studies; computed-tomography-guided needle biopsy; Diagnostic Errors - prevention & control; Elastic Tissue - pathology; Female; Fibroblasts - pathology; fibrosis; Humans; Iatrogenic Disease; lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Staging; Noguchi classification; Predictive Value of Tests; Pulmonary Fibrosis - etiology; Pulmonary Fibrosis - pathology; Radiography, Interventional; Time Factors; Tomography, X-Ray Computed
• ISSN: 1341-1098; 2186-1005; 2186-1005

After computed-tomography-guided needle biopsy (CTNB), the lung may undergo iatrogenic fibrosis (post-CTNB fibrosis), which can be misdiagnosed as tumor-induced fibrosis. The purpose of the study was to examine if an accurate evaluation of pulmonary adenocarcinoma can be made using the Noguchi classification (type A or B vs. type C), even after CTNB. The subjects were 71 patients with primary pulmonary adenocarcinoma of 20 mm or less that had been resected surgically after CTNB. Twenty-four patients who did not undergo a preoperative biopsy served as controls. Resected specimens were stained with hematoxylin-eosin (HE) and elastic-fiber staining for a precise observation of fibrosis. The period from CTNB to surgery ranged from 12 to 153 days. Post-CTNB fibrosis consisted primarily of collagen fibers with a few thin elastic fibers observed only with high magnification, which was able to distinguish post-CTNB fibrosis in 39 of 48 patients (81.3%) with bronchioloalveolar carcinoma (BAC) lesions (types A/B/C) and in 6 of 23 patients (26.1%) without BAC lesions (types D/E/F/E + F), showing a significant difference (p <0.0001). In the control group, no lesions that resembled post-CTNB fibrosis were observed. An evaluation of pulmonary adenocarcinoma by Noguchi classification can be accurately performed even after CTNB.