Abstract
Background: It is common for biopsies of concerning pulmonary nodules to result in cytologic “atypia” on biopsy, which may represent a benign response or a false negative finding. This investigation evaluated time to diagnosis and factors which may predict an ultimate diagnosis of lung cancer in these patients with atypia cytology on lung nodule biopsy. Methods: This retrospective study included patients of the Stony Brook Lung Cancer Evaluation Center who had a biopsy baseline diagnosis of atypia between 2010 and 2020 and were either diagnosed with cancer or remained disease free by the end of the observation period. Cox Proportional Hazard (CPH) Models were used to assess factor effects on outcomes. Results: Among 106 patients with an initial diagnosis of atypia, 80 (75%) were diagnosed with lung cancer. Of those, over three-quarters were diagnosed within 6 months. The CPH models indicated that PET positivity (SUV ≥ 2.5) (HR = 1.74 (1.03, 2.94)), nodule size > 3.5 cm (HR = 2.83, 95% CI (1.47, 5.45)) and the presence of mixed ground glass opacities (HR = 2.15 (1.05, 4.43)) significantly increased risk of lung cancer. Conclusion: Given the high conversion rate to cancer within 6 months, at least tight monitoring, if not repeat biopsy may be warranted during this time period for patients diagnosed with atypia.
Highlights
The purpose of this study was to evaluate the duration of time and potential risk factors associated with the development of lung cancer among patients with an initial diagnosis of atypia
This study retrospectively examined the electronic medical records (EMR) of all patients seen by the Lung Cancer Evaluation Center (LCEC) at the Stony Brook Cancer
While adenocarcinoma (63%) and squamous cell (15%) were the primary cancer types subsequently diagnosed among cases, pneumonia (23%), fibrosis (19%), and chronic inflammation (12%) were the primary histologic diagnoses among patients who remained cancer-free
Summary
The most accessible sites are usually chosen for biopsy, [5] as different approaches carry different yields [6]. As it is not uncommon for tissue samples to be classified as having atypical cellularity, repeat biopsies or surgical interventions are further recommended [7]. It remains unclear, how often a cytologic diagnosis of atypia is found to be a malignancy, and in what time frame this lung cancer diagnosis occurs. The purpose of this study was to evaluate the duration of time and potential risk factors associated with the development of lung cancer among patients with an initial diagnosis of atypia
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