title: Inaccuracy of lung adenocarcinoma subtyping using preoperative biopsy specimens.
abstract: 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.
authors.affiliation: Division of Chest Medicine, Department of Internal Medicine, Yuanlin Christian Hospital, Changhua, Taiwan.
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Huang
authors.affiliation: Department of Pathology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Pin-Zuo
authors.initials: PZ
authors.lastname: Ko
authors.affiliation: Division of Chest Medicine, Department of Internal Medicine, Everan Hospital, Taichung, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yao
authors.affiliation: Department of Radiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Nan
authors.initials: CN
authors.lastname: Hsu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Fang
authors.affiliation: School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Yeh
authors.initials: CY
authors.lastname: Tu
authors.affiliation: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan. Electronic address: redman0127@gmail.com.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Chen
mesh_terms: D000077192:Adenocarcinoma of Lung / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: computed tomography–guided 18-gauge core needle biopsy (CTNB); high-grade adenocarcinoma; lung adenocarcinoma; radial probe endobronchial ultrasound (R-EBUS); subtype