Clinical Implications of “Atypia” on Biopsy: Possible Precursor to Lung Cancer?

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.

Simplicity Is the Ultimate Sophistication: A Unified Definition of Diagnostic Yield Is Imperative for the Appropriate Diagnosis of Peripheral Lung Lesions

“…This paper also effectively highlights the difficulty surrounding the pathway of what to do with nondiagnostic bronchoscopy and just how unencumbered we are by high-quality data as we decide on the next steps for nonmalignant biopsies. Atypical cells, which have been treated as both nondiagnostic and diagnostic in the literature, may show a 73–75% likelihood of progressing to cancer at a single center ( 17 , 18 ), but there are tremendous gaps in understanding these outcomes that must be studied to provide clinicians with an evidence-based pathway toward improved tissue sampling. Until the finding of “atypical cells” is robustly understood, it should not be treated as a pathologic endpoint or “diagnostic” procedure, and further study of this diagnosis is critically needed.…”