An accurate diagnosis of Noguchi classification is possible after the modification of preoperative biopsy-induced fibrosis.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
An evaluation of pulmonary adenocarcinoma by Noguchi classification can be accurately performed even after CTNB.
Nakajima
Yuki
Y
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Kawamoto
Masashi
M
Koizumi
Kiyoshi
K
Tajima
Hiroyuki
H
Fukuda
Yuh
Y
Tsuchiya
Shin-Ichi
S
Shimizu
Kazuo
K
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D003951:Diagnostic Errors / Q000517:prevention & control; D004547:Elastic Tissue / Q000473:pathology; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D007049:Iatrogenic Disease; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000473:pathology*; D015641:Radiography, Interventional; D013997:Time Factors; D014057:Tomography, X-Ray Computed