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Cytomorphological identification of advanced pulmonary adenocarcinoma harboring KRAS mutation in lymph node fine‐needle aspiration specimens: Comparative investigation of adenocarcinoma with KRAS and EGFR mutations
Author(s) -
Song Dae Hyun,
Lee Boram,
Shin Yooju,
Choi In Ho,
Ha Sang Yun,
Lee Jae Jun,
Hong Min Eui,
Choi YoonLa,
Han Joungho,
Um SangWon
Publication year - 2015
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.23242
Subject(s) - kras , medicine , adenocarcinoma , lymph node , pathology , cytopathology , cancer , cancer research , cytology , colorectal cancer
Background Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) mutation in pulmonary adenocarcinoma is clinically important due to its association with resistance to EGFR inhibitors and poor prognosis. To our knowledge, there has not been a comparative study focusing on cytological nuclear features of pulmonary adenocarcinoma harboring KRAS mutation (KRAS‐AD). Hence, we compared the cytomorphology of metastatic KRAS‐AD and EGFR‐positive adenocarcinoma (EGFR‐AD) in aspiration specimens from lymph nodes. Methods Forty lymph node aspiration specimens from forty KRAS‐AD patients were collected at Samsung Medical Center (Seoul, Korea) from 2009 to 2013. As a control group, 40 EBUS‐FNA lymph node specimens from 20 EGFR‐AD patients were collected. EGFR‐AD specimens were evaluated at Samsung Medical Center (Seoul, Korea) from 2012 to 2013. All 80 specimens were histologically confirmed to metastatic adenocarcinoma. Two pathologists performed a blinded review of all specimens. Results Compared with EGFR‐AD, KRAS‐AD exhibited more severe nuclear pleomorphism ( P < 0.001), coarse chromatin ( P = 0.001), cherry‐red nucleoli ( P < 0.001) and naked tumor cells ( P = 0.002) with necrotic ( P < 0.001) and neutrophilic ( P = 0.008) background. Conclusions Our study provides the first demonstration of cytomorphologic differentiation between metastatic KRAS‐AD and metastatic EGFR‐AD in lymph node aspiration specimens. Diagn. Cytopathol. 2015;43:539–544. © 2014 Wiley Periodicals, Inc.