An attempt to use the WHO typing in the histological classification of lung carcinomas

Our plain-English summary of An attempt to use the WHO typing in the histological classification of lung carcinomas, by A. Reinilä, K. Dammert (Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology, 1974).

The study

• Authors: A. Reinilä, K. Dammert
• Journal: Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology
• Published: 1974;82(6):783-90
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

An earlier lung carcinoma material collected during 1968-1971 was re-examined. The series comprised 175 cases, 91 (52 per cent) of which were detected by biopsy and 84 (48 per cent) at autopsy. The significance of the results was evaluated in the light of the clinical course of the disease, mainly in the light of the survival. Epidermoid carcinomas were classified into two groups, one comprising carcinomas with high or moderate differentiation and another comprising those with slight differentiation, which were then dealt with as separate categories. The distribution was as follows: 68 (38.85 per cent) highly or moderately differentiated epidermoid carcinomas, including 6 of the clear-cell type which are here classified as belonging to this group, and 27 (15.44 per cent) slightly differentiated epidermoid carcinomas, making up a total of 95 (54.29 per cent). Parvocellular anaplastic carcinomas numbered 52 (29.72 per cent) and adenocarcinomas 15 (8.57 per cent) among which 12 (6.86 per cent) were bronchogenic and 3 (1.71 per cent) bronchiolo-alveolar. Large-cell carcinoma, mucous gland carcinoma, combined epidermoid-adenocarcinoma and carcinosarcoma each occurred once (0.57 per cent). There were a further 7 (4.0 per cent) unclassifiable cases and 2 (1.14 per cent) mesotheliomas. Survival in the two groups of epidermoid carcinomas was seen to differ significantly. As regards the 3 patients with clear-cell carcinomas survival was notably good. It was difficult histologically to draw a line between the slightly differentiated epidermoid carcinoma and the fusiform and polygonal subtypes of the anaplastic parvocellular carcinoma. Nor was there any significant difference in survival in these groups.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This study from the University of Oulu, Finland, re-examined tissue samples from 175 lung carcinoma cases seen in 1968-1971 (91 from biopsy, 84 from autopsy). It tested the World Health Organization (WHO) histological classification of lung tumours against how long patients survived. The article does not discuss asbestos or any other exposure. Epidermoid carcinomas made up 95 cases (54.29 per cent): 68 highly or moderately differentiated (including 6 clear-cell carcinomas) and 27 slightly differentiated. There were 52 small-cell (parvocellular) anaplastic carcinomas, 15 adenocarcinomas, 7 unclassifiable cases and 2 mesotheliomas, which were not described further. Survival was best for highly or moderately differentiated epidermoid carcinoma, and all 12 patients still alive were in that group. Survival with slightly differentiated epidermoid carcinoma did not differ significantly from survival with the fusiform and polygonal subtypes of small-cell carcinoma, which were also hard to tell apart under the microscope. The authors concluded that the two epidermoid grades could be treated as separate groups. They noted that the small series detracts from the value of the findings.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective re-examination of pathology specimens (biopsy and autopsy) with survival follow-up of 2-6 years
• Who was studied: 175 lung carcinoma cases (from 181 examined; 6 samples were too small or necrotic) at the Department of Pathology, University of Oulu, Finland, 1968-1971. Of these, 91 were detected by biopsy and 84 at autopsy.
• Exposure: No exposure was studied. The article compares tumour types and treatments and does not mention asbestos.
• Main results:
  • Of 175 cases: 95 (54.29 per cent) epidermoid carcinomas (68 highly or moderately differentiated, including 6 clear-cell; 27 slightly differentiated), 52 (29.72 per cent) parvocellular anaplastic carcinomas, 15 (8.57 per cent) adenocarcinomas, 7 (4.0 per cent) unclassifiable cases and 2 (1.14 per cent) mesotheliomas.
  • Survival was clearly best in highly or moderately differentiated epidermoid carcinoma. The difference from slightly differentiated epidermoid carcinoma and from parvocellular carcinoma was highly significant (p less than 0.001). Survival was also significantly better than with adenocarcinoma (p less than 0.05).
  • 12 patients in the total series were still alive. All were in the highly or moderately differentiated epidermoid group, and 3 of them had clear-cell carcinoma.
  • Survival with slightly differentiated epidermoid carcinoma was not significantly different from survival with the polygonal and fusiform subtypes of parvocellular carcinoma. Survival with the polygonal and fusiform subtypes differed significantly from the oat-cell subtype (p less than 0.001).
  • Of the 36 cases diagnosed only at autopsy, 18 were parvocellular anaplastic carcinomas, 12 of them of the oat-cell subtype. Oat-cell carcinoma had metastasized extensively in every case.
  • In epidermoid carcinoma, patients treated by operation alone survived significantly longer than those given both operation and radiotherapy (p less than 0.05). Those given radiotherapy alone survived significantly longer than untreated patients (p less than 0.001).
• The authors' conclusion: The authors concluded that slightly differentiated and highly or moderately differentiated epidermoid carcinomas could usefully be treated as separate groups. They suggested slightly differentiated epidermoid carcinoma might be grouped with the fusiform and polygonal parvocellular carcinomas, since these are hard to distinguish and showed no significant survival difference. They added that difficulties remain in applying the WHO classification.
• Limitations the authors state:
  • The series was small, which the authors say detracts from the value of the findings and limits the weight of the survival rates.
  • The work was not epidemiological, so the material is somewhat selective.
  • The choice of treatment and its outcome depend on other factors, such as tumour extent and other illnesses, so the authors drew no further conclusions about treatments.
  • The data were not detailed enough to compare tumour size, spread or ulceration of the bronchial lining.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Histological Subtype, Carcinoma, Biopsy, Autopsy, Adenocarcinoma, Bronchogenic Carcinoma, Mesothelioma.

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