Should Pathologically Noninvasive Lung Adenocarcinoma Larger Than 3 cm Be Classified as T1a?

Inafuku, Kenji; Yokose, Tomoyuki; Ito, Hiroyuki; Narimatsu, Hiroto; Samejima, Joji; Nagashima, Takuya; Nakayama, Haruhiko; Suzuki, Masaki; Yamada, Katsushi; Masuda, Munetaka

doi:10.1016/j.athoracsur.2019.06.055

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…None of the 10 patients had a recurrence. A previous study also reported that the prognosis of patients with pathologically noninvasive adenocarcinoma with a total size larger than 3 cm was comparable to that of AIS 25. Therefore, the AIS should not be limited to ≤3 cm.…”

Section: Discussionmentioning

confidence: 88%

Preference of grade and lymphovascular invasion over invasive size measurement in stage I lung adenocarcinoma

et al. 2022

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AimsAlthough it is necessary to measure the invasive size of lung adenocarcinoma with a lepidic component, it is not uncommon to have trouble in measuring the invasive size of lung adenocarcinoma. This study examined whether there were other stronger prognostic factors than invasive size.MethodsWe characterised the clinicopathological features associated with recurrence-free survival (RFS) of 686 patients with the pathological stage (p-Stage) I lung adenocarcinoma. Moreover, we compared the area under the curve (AUC) values for recurrence between various combinations of pathological-baseline (age & sex & p-Stage based on invasive size) (B(i)) and several prognostic factors, and various combinations of p-baseline based on total tumour size (B(t)) and several prognostic factors.ResultsAUC showed no significant differences between B(i) & new International Association for the Study of Lung Cancer grade (G) or vascular invasion (V), and B(t) & G or V. AUC was the highest in B & G & lymphatic invasion (L) & V. RFS was significantly shorter in patients with G3 OR L(+) OR V(+) than in those with G≤2 AND L(-) AND V(-) in each p-Stage based on invasive size (p-Stage(i)) and p-Stage based on total tumour size (p-Stage(t)) (p<0.05), and there were no significant differences in RFS between each p-Stage(i) and p-Stage(t).ConclusionsIn any invasive size or total tumour size of p-Stage I lung adenocarcinoma, G, L and V are more powerful prognostic factors than the size criteria of p-Stage. Therefore, pathologists should focus on these pathological findings.

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Section: Discussionmentioning

confidence: 88%

Preference of grade and lymphovascular invasion over invasive size measurement in stage I lung adenocarcinoma

et al. 2022

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Section: Methodsmentioning

confidence: 99%

“…Noninvasive alveolar collapse was defined as a focus of the structural alveolar collapse with no active fibroblast proliferation and preserved elastic fiber skeleton, and its presence or absence was evaluated. 20 Two observers (a thoracic radiologist with 8 years of experience and another thoracic radiologist with 36 years of experience) reviewed all CT and MRI findings. The readers evaluated the nodules on CT with a 1-mm slice and on MRI with a 3-mm slice.…”

Section: Ex-vivo Mri Versus Ctmentioning

confidence: 99%

<i>Ex-vivo</i> 1.5T MR Imaging versus CT in Estimating the Size of the Pathologically Invasive Component of Lung Adenocarcinoma Spectrum Lesions

et al. 2024

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The purpose of this study was to investigate whether ex-vivo MRI enables accurate estimation of the invasive component of lung adenocarcinoma. Methods:We retrospectively reviewed 32 patients with lung adenocarcinoma who underwent lung lobectomy. The specimens underwent MRI at 1.5T. The boundary between the lesion and the normal lung was evaluated on a 5-point scale in each three MRI sequences, and a one-way analysis of variance and post-hoc tests were performed. The invasive component size was measured histopathologically. The maximum diameter of each solid component measured on CT and MR T1-weighted (T1W) images and the maximum size obtained from histopathologic images were compared using the Wilcoxon signed-rank test. Inter-reader agreement was evaluated using intraclass correlation coefficients (ICC).Results: T1W images were determined to be optimal for the delineation of the lesions (P < 0.001). The histopathologic invasive area corresponded to the area where the T1W ex-vivo MR image showed a high signal intensity that was almost equal to the intravascular blood signal. The maximum diameter of the solid component on CT was overestimated compared with the maximum invasive size on histopathology (mean, 153%; P < 0.05), while that on MRI was evaluated mostly accurately without overestimation (mean, 108%; P = 0.48). The interobserver reliability of the measurements using CT and MRI was good (ICC = 0.71 on CT, 0.74 on MRI). Conclusion:Ex-vivo MRI was more accurate than conventional CT in delineating the invasive component of lung adenocarcinoma.

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“…Tumours with > 5 mm of invasive growth are classified as invasive adenocarcinoma regardless of the total tumour size. Lepidic tumours that are > 3 cm are classified as lepidic adenocarcinomas, as the prognosis of lesions is not known 14 . In 2015, these diagnoses were accepted into the World Health Organisation's classification of thoracic tumours 15 .…”

Section: Invasive Sizementioning

confidence: 99%

“…Lepidic tumours that are > 3 cm are classified as lepidic adenocarcinomas, as the prognosis of lesions is not known. 14 In 2015, these diagnoses were accepted into the World Health Organisation's classification of thoracic tumours. 15 Multiple studies have demonstrated that neither AIS nor MIA are associated with recurrence when they present as single pulmonary lesions, and the need for two categories to separate these tumours is currently debated.…”

Section: Invasive Sizementioning

confidence: 99%

Updates on lung adenocarcinoma: invasive size, grading and STAS

Willner,

Narula,

Moreira

2023

Histopathology

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Advancements in the classification of lung adenocarcinoma have resulted in significant changes in pathological reporting. The eighth edition of the tumour–node–metastasis (TNM) staging guidelines calls for the use of invasive size in staging in place of total tumour size. This shift improves prognostic stratification and requires a more nuanced approach to tumour measurements in challenging situations. Similarly, the adoption of new grading criteria based on the predominant and highest‐grade pattern proposed by the International Association for the Study of Lung Cancer (IASLC) shows improved prognostication, and therefore clinical utility, relative to previous grading systems. Spread through airspaces (STAS) is a form of tumour invasion involving tumour cells spreading through the airspaces, which has been highly researched in recent years. This review discusses updates in pathological T staging, adenocarcinoma grading and STAS and illustrates the utility and limitations of current concepts in lung adenocarcinoma.

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Should Pathologically Noninvasive Lung Adenocarcinoma Larger Than 3 cm Be Classified as T1a?

Cited by 8 publications

References 23 publications

Preference of grade and lymphovascular invasion over invasive size measurement in stage I lung adenocarcinoma

Preference of grade and lymphovascular invasion over invasive size measurement in stage I lung adenocarcinoma

<i>Ex-vivo</i> 1.5T MR Imaging versus CT in Estimating the Size of the Pathologically Invasive Component of Lung Adenocarcinoma Spectrum Lesions

Updates on lung adenocarcinoma: invasive size, grading and STAS

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