Nonsmall Cell Lung Cancer: The pathologist’s role in diagnosis and management

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50%

60%

70%

80%

PD Squamous cell carcinoma

PD Adenocarcinoma

PD NSCLC immunohistochemically consistent with squamous cell carcinoma

PD NSCLC, immunohistochemically consistent with adenocarcinoma

The survival curve for such lesions is more consistent with a non-invasive tumor

Changing the diagnostic terminology every few years supports better practice

Invasive adenocarcinomas in lung needed a precursor lesion

This reclassification helps surgeons with CT correlations

Solitary ground glass pulmonary lesion

Multifocal ground glass infiltrates

Lobar ground glass infiltrates

Solid spiculated nodule

Early lymphatic dissemination

Pleural involvement

“Aerogenous” spread within the lung

Areas of central fibrosis in lesions

Clear cell, glandular, and lepidic

Mucinous and non-mucinous

Glandular, non-glandular, lepidic

“Aeroginous”, mucinous, and cuboidal

The term BAC should be discontinued.

Lepidic tumors 3 cm or less should be diagnosed as “AIS”.

Lepidic tumors 3 cm or less with 5 mm or less of invasion should be called “minimally invasive adenocarcinoma” (MIA)

All of the above

‘Mucinous adenocarcinoma”

“Mucinous adenocarcinoma with lepidic growth, cannot exclude invasion”

“Mucinous tumor with lepidic growth, cannot exclude invasion”

“Mucinous adenocarcinoma in situ, cannot exclude invasion”

Redefines the T stage of a tumor using alphabetic letters (TA, TB, TC, etc)

Is based on data from 100,000 patient outcomes

Has added a modifier for vascular invasion (V1, V2, etc)

Has not yet been implemented in practice

Adds a new modifier for extent of pleural invasion (PL1, PL2, PL3)

Further subdivides T1, T2, and T3 stages by size and PL status

Added a new stage for “adenocarcinoma in situ”: AIS-1

Downstages same lobe nodules from T4 to T3

Downstages ispilateral multiple nodules from M1 to T4.

7% => 16%

10% => 25%

12% => 22%

8% => 21%

Help determine which patients are best suited for surgical resection

Determine the molecular pathology of a given patient’s lung cancer

Identify patients more likely to respond to a given pharmacotherapy

Decrease the toxicity of modern anticancer therapies in individual patients

Help define the presence of epidermal growth factor receptors and their ligands

Identify which patients are most likely to benefit from certain cytoxic chemotherapies

Cannot be used for selecting therapy for advanced lung cancer patients

Are no longer available in the U.S. for predictive testing

Adenocarcinoma in situ (AIS)

Microinvasive adenocarcinoma (MIA)

Adenocarcinoma with micropapillary pattern

Papillary adenoma of type II cells

Adenocarcinoma in situ (AIS)

Microinvasive adenocarcinoma (MIA)

Adenocarcinoma with micropapillary pattern

Papillary adenoma of type II cells

Adenocarcinoma in situ (AIS)

Microinvasive adenocarcinoma (MIA)

Atypical adenomatous hyperplasia (AAH)

Papillary adenoma of type II cells

Adenocarcinoma, NOS

T1a, PL0

T1b, PL0

T2 (PL1)

T2 (PL2)

T2 (PL3)

Atypical adenomatous hyperplasia

Papillary adenoma

Bronchioloalveolar carcinoma, nonmucinous type

Adenocarcinoma with lepidic growth cannot exclude invasive adenocarcinoma

Fetal type adenocarcinoma with micropapillary growth

Atypical adenomatous hyperplasia

Papillary and mucinous adenoma

Bronchioloalveolar carcinoma, mucinous type

Mucinous adenocarcinoma