Gross handling of pulmonary resection specimen: maintaining the 3-dimensional orientation

Currently, there is no established guidance on how to process and evaluate resected lung cancer specimens after neoadjuvant therapy in the setting of clinical trials and clinical practice. There is also a lack of precise definitions on the degree of pathologic response, including major pathologic response or complete pathologic response. For other cancers such as osteosarcoma and colorectal, breast, and

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“…19,73 Detailed CT pathologic correlation to maintain three-dimensional orientation can be helpful in certain cases. 74 Recommendation 3:.…”

Section: Gross Assessment and Processing Lung Tumor Bedmentioning

confidence: 99%

IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy

Travis

Đačić

Wistuba

et al. 2020

Journal of Thoracic Oncology

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274

234

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“…Based on expert opinion consensus, current best practice recommendations for the diagnosis and management of treatment-naive advanced NSCLC and progressive/recurrent treated NSCLC are summarised in Fig. 3 [112,127,128]. Best practices require the application of current scientific knowledge to clinical practice in the context of available resources.…”

Section: Summary Of Best Practice Recommendationsmentioning

confidence: 99%

The evolving landscape of biomarker testing for non-small cell lung cancer in Europe

et al. 2021

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The discovery of oncogenic driver mutations rendering non-small cell lung cancer (NSCLC) targetable by smallmolecule inhibitors, and the development of immunotherapies, have revolutionised NSCLC treatment. Today, instead of non-selective chemotherapies, all patients with advanced NSCLC eligible for treatment (and increasing numbers with earlier, less extensive disease) require fast and comprehensive screening of biomarkers for first-line patient selection for targeted therapy, chemotherapy, or immunotherapy (with or without chemotherapy). To avoid unnecessary re-biopsies, biomarker screening before first-line treatment should also include markers that are actionable from second-line onwards; PD-L1 expression testing is also mandatory before initiating treatment.Population differences exist in the frequency of oncogenic driver mutations: EGFR mutations are more frequent in Asia than Europe, whereas the converse is true for KRAS mutations. In addition to approved first-line therapies, a number of emerging therapies are being investigated in clinical trials. Guidelines for biomarker testing vary by country, with the number of actionable targets and the requirement for extensive molecular screening strategies expected to increase. To meet diagnostic demands, rapid screening technologies for singledriver mutations have been implemented. Improvements in DNA-and RNA-based next-generation sequencing

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“…For fixation, the whole right or left lung was infused with 10% neutral buffered formalin via the main bronchus and subsequently submerged in that fixative for at least 48 h. Then, 5‐mm thick slices were cut in the transversal craniocaudal plane. Gross examination and sampling for microscopical examination of the lung was performed by a specialized lung pathologist as described before 14 in order to ensure the direct correlation with the chest CT. In short, the pathologist begins with orientation of the specimen, maintaining the three‐dimensional (3D) anatomical orientation (in axial, sagittal and coronal planes).…”

Section: Methodsmentioning

confidence: 99%

COVID‐19: Histopathological correlates of imaging patterns on chest computed tomography

et al. 2021

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Background and objective Patients with coronavirus disease 2019 (COVID‐19) pneumonia present with typical findings on chest computed tomography (CT), but the underlying histopathological patterns are unknown. Through direct regional correlation of imaging findings to histopathological patterns, this study aimed to explain typical COVID‐19 CT patterns at tissue level. Methods Eight autopsy cases were prospectively selected of patients with PCR‐proven COVID‐19 pneumonia with varying clinical manifestations and causes of death. All had been subjected to chest CT imaging 24–72 h prior to death. Twenty‐seven lung areas with typical COVID‐19 patterns and two radiologically unaffected pulmonary areas were correlated to histopathological findings in the same lung regions. Results Two dominant radiological patterns were observed: ground‐glass opacity (GGO) (n = 11) and consolidation (n = 16). In seven of 11 sampled areas of GGO, diffuse alveolar damage (DAD) was observed. In four areas of GGO, the histological pattern was vascular damage and thrombosis, with (n = 2) or without DAD (n = 2). DAD was also observed in five of 16 samples derived from areas of radiological consolidation. Seven areas of consolidation were based on a combination of DAD, vascular damage and thrombosis. In four areas of consolidation, bronchopneumonia was found. Unexpectedly, in samples from radiologically unaffected lung parenchyma, evidence was found of vascular damage and thrombosis. Conclusion In COVID‐19, radiological findings of GGO and consolidation are mostly explained by DAD or a combination of DAD and vascular damage plus thrombosis. However, the different typical CT patterns in COVID‐19 are not related to specific histopathological patterns. Microvascular damage and thrombosis are even encountered in the radiologically normal lung.

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Gross handling of pulmonary resection specimen: maintaining the 3-dimensional orientation

Cited by 22 publications

References 25 publications

IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy

IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy

The evolving landscape of biomarker testing for non-small cell lung cancer in Europe

COVID‐19: Histopathological correlates of imaging patterns on chest computed tomography

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