The Novel Histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification System of Lung Adenocarcinoma Is a Stage-Independent Predictor of Survival

Warth, Arne; Muley, Thomas; Meister, Michael; Stenzinger, Albrecht; Thomas, Michael; Schirmacher, Peter; Schnabel, Philipp A.; Budczies, Jan; Hoffmann, Hans; Weichert, Wilko

doi:10.1200/jco.2011.37.2185

Cited by 597 publications

(386 citation statements)

References 25 publications

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“…Since solid adenocarcinomas have a poor prognosis, papillary and acinar adenocarcinomas have an intermediate prognosis, and lepidic adenocarcinomas have a favorable prognosis (15). In order to better carry out statistics, we classified lung adenocarcinoma in four groups.…”

Section: Histological Characteristicsmentioning

confidence: 99%

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Miao¹,

Zhang²,

Zou³

et al. 2017

Transl. Lung Cancer Res.

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Section: Histological Characteristicsmentioning

confidence: 99%

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Miao¹,

Zhang²,

Zou³

et al. 2017

Transl. Lung Cancer Res.

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“…Increasing numbers of studies have focused on the histological subtypes of LAC following the novel classification proposed by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) (12,13). Finding the association between the histological subtype and mutation status of LAC patients is crucial.…”

Section: Introductionmentioning

confidence: 99%

Association between the histological subtype of lung adenocarcinoma, EGFR/KRAS mutation status and the ALK rearrangement according to the novel IASLC/ATS/ERS classification

et al. 2016

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Abstract. The present study aimed to investigate the association between epidermal growth factor receptor (EGFR)/Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations, anaplastic lymphoma receptor tyrosine kinase (ALK) rearrangements and the morphological characteristics of lung adenocarcinoma (LAC), according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification in a large group of patients with primary LAC. A total of 200 patients with invasive LAC who had undergone complete resections at the Beijing Chest Hospital (Beijing, China) were randomly selected. The morphology of the samples was reassessed in 5% increments by two pathologists, according to the IASLC/ATS/ERS scheme. EGFR and KRAS mutations were tested by direct DNA sequencing. ALK rearrangements were screened by immunohistochemistry on a Benchmark XT stainer. The data revealed that EGFR and KRAS mutations, and ALK rearrangements were identified in 46.0% (92/200), 9.0% (18/200) and 11.5% (23/200) of the patients, respectively. The EGFR/KRAS mutations and ALK rearrangements were mostly exclusive. However, 1 patient exhibited the coexistence of the EGFR (at exon 20) and KRAS (codon 12) mutations, and another patient exhibited the coexistence of the EGFR mutation (at exon 21) and the ALK gene fusion. EGFR mutations were indicated to be closely associated with the acinar predominant (43/77; 55.8%; P=0.030) and papillary predominant (26/49; 53.1%; P=0.006) subtypes. KRAS mutations were more commonly associated with the solid predominant subtype (9/52; 17.3%; P=0.023) and invasive mucinous LAC (5/10; 50.0%; P=0.004), and less commonly associated with the acinar predominant subtype (1/77; 1.3%; P=0.002). ALK rearrangements more commonly occurred in the solid predominant subtype compared with other subtypes (13/52; 25%; P=0.002), and less commonly occurred in the papillary predominant subtype (1/49; 2.0%; P=0.004). Tumors harboring ALK rearrangements were characterized by signet-ring cell (7/9; 77.8%; P<0.0001) and cribriform (7/12; 58.3%; P<0.0001) patterns. The association between the mutation status and histological subtype in LAC was distinct. The predominant subtype according to the IASLC/ATS/ERS classification provided important information for gene mutations and integrated clinical findings to improve the treatment of LAC patients.

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“…[1][2][3] The prognostic significance of histological subtyping of lung adenocarcinoma has been demonstrated in several studies and histological subtyping in 5% increments of the surgically resected lung adenocarcinoma has been recommended by the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) classification of lung adenocarcinoma, and most recently by the 2015 WHO classification of tumors of the lung. [4][5][6][7][8] Solid and micropapillary patterns have been associated with poor outcome in stage I lung adenocarcinoma, whereas tumors with lepidic growth pattern showed favorable outcome. 5,[9][10][11][12] Mucinous morphology has also been reported as a negative prognostic indicator.…”

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confidence: 99%

Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections

et al. 2015

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Histological subtyping of surgically resected lung adenocarcinoma has been shown to be of prognostic significance, and limited surgical resection has been proposed as a treatment of choice for early-stage lung adenocarcinoma. The accuracy of histological subtyping has been recently assessed in the surgical resection and small biopsy specimens; however, the accuracy of intraoperative subtyping on frozen sections remains relatively unknown. The aim of this study was to determine diagnostic accuracy and interobserver variability in histological subtyping of lung adenocarcinoma on intraoperative frozen sections. Overall, 112 consecutive cases of surgically resected stage I lung adenocarcinoma were reviewed independently by three pathologists. Histological patterns (acinar, lepidic, papillary, micropapillary, and solid) and mucinous variant were recorded in 5% increments for each intraoperative frozen and permanent sections. Primary and secondary histological patterns were assigned in each case. Kappa scores were calculated to evaluate agreement between pathologists in the assessment of histological subtype on intraoperative frozen sections versus permanent sections. Overall agreement between intraoperative frozen and permanent sections was moderate for primary pattern (69.7% of cases), with kappa scores ranging from 0.43 to 0.58, with more consistent agreement for stage IA tumors. Kappa scores for the secondary pattern ranged from 0.16 to 0.32. Acinar and solid patterns were most likely to be correctly identified as primary growth patterns. Micropapillary pattern was recognized in only 11-55% of cases. The main reasons for discrepancies between intraoperative frozen and permanent sections were inadequate sampling and poor quality of frozen sections. Our study suggests that it is difficult to predict the primary adenocarcinoma pattern on a single representative frozen section. This observation suggests a potential impact on the extent of frozen section sampling by pathologists at the time of intraoperative consultation, if surgical management of stage I lung adenocarcinoma will be guided by its histological subtype.

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The Novel Histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification System of Lung Adenocarcinoma Is a Stage-Independent Predictor of Survival

Cited by 597 publications

References 25 publications

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Association between the histological subtype of lung adenocarcinoma, EGFR/KRAS mutation status and the ALK rearrangement according to the novel IASLC/ATS/ERS classification

Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections

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