肺与呼吸系统医学

A Clinico-Radiological and Pathological Evaluation of Bronchogenic Carcinoma with Special Reference to Immunohistochemistry Ki-67 in a Tertiary Care Hospital of Eastern India

Abstract

Jena P, Pattnaik M, Patra JK, Meher BK, Sethy HK, Mohanty T and Panda G

Introduction: Lung cancer is the most commonly diagnosed cancer and leading cause of cancer related death worldwide. Ultimate determinant of patient management lies on histopathological evaluation of the disease process. Immunohistochemistry extends to the determination of cell lineage, determining the primary site of tumour origin and contributing to decisions on prognosis and targeted treatment. The proliferative activity of Ki-67 immuno-staining on biopsy specimens is known to be a valuable prognostic factor.
Aims and objective: To study clinicoradiological correlation with different histological type of bronchogenic carcinoma by different diagnostic modalities to establish diagnosis and to study immunomarker KI-67 in different histological type of lung cancer.
Materials and methods: The study was conducted in the Department of Pulmonary Medicine, SCB Medical College, and Cuttack in collaboration with Department of Pathology during the period May 2016 to December 2017.50 patients of various age groups with strong clinical suspicion and/or chest radiographic diagnosis of lung cancer were included in this study from IPD of Pulmonary Medicine. Patient having known coagulopathy, history of recent myocardial infarction and unwilling to give consent were excluded from the study.
Discussion: The present study constituted 31 males (62%) and 19 females (38%) out of the total 50 with a M: F ratio of 1.63:1. Cough (74%) was the most common symptoms followed by breathlessness (56%) and chest pain (52%). Pallor (44%) and clubbing (28%) most commonly seen followed by lymphadenopathy. The most common radiological presentation was mass lesion (52%) followed by combined presentation (44%) and collapseconsolidation (40%). Various diagnostic modalities used were fibre-optic bronchoscopy with biopsy (42.6%) followed by thoracoscopy and biopsy (23.4%). Evaluated biopsy specimen showed definite malignancy in 80%, inflammatory lesions in 8%, tuberculosis in 2%, fungal in 2% and inconclusive in 8% cases. Adenocarcinoma (45%) followed by Squamous cell Carcinoma (40%) were most commonly evaluated malignant lesions. Squamous cell carcinoma is associated with high Tumor Proliferative Fraction (TPF) with higher mean ki-67% value (46.5%) followed by small cell carcinoma (33.3%) and adenocarcinoma (28.2%).
Conclusion: Clinico-radiological examination along with histopathological evaluation of bronchogenic carcinoma is always necessary for accurate diagnosis, which help in proper sub-classification of tissue type in right clinical context. Immuno-histochemical markers help in subtyping the poorly differentiated carcinomas and predicting clinical evolution and response to treatment. Ki-67 antigen expression is useful to elaborate a therapeutic strategy before surgery or, alternatively, could be relied on to select chemotherapy protocols in non resectable lung carcinomas.