Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.
Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.
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DOI：
10.5858/arpa.2012-0263-ra
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发表时间：
2013-05
影响因子：
4.6
通讯作者：
Tsao M
中科院分区：
文献类型：
--
作者：
Travis WD;Brambilla E;Noguchi M;Nicholson AG;Geisinger K;Yatabe Y;Ishikawa Y;Wistuba I;Flieder DB;Franklin W;Gazdar A;Hasleton PS;Henderson DW;Kerr KM;Petersen I;Roggli V;Thunnissen E;Tsao M
新的国际肺癌研究协会/美国胸科学会/欧洲呼吸学会肺腺癌分类首次为小活检和细胞学检查中的肺癌诊断提供了标准化术语;这主要不是由以前的世界卫生组织分类解决的。直到最近，对NSCLC的进一步分类还没有治疗意义，因此很少关注小组织样本中腺癌和鳞状细胞癌的区别。近年来，随着几种治疗选择的发现，这种情况发生了巨大变化，这些治疗选择仅适用于腺癌或NSCLC患者，而不是鳞状细胞癌患者。这包括建议使用特殊染色作为辅助诊断，特别是在常规光学显微镜检查未显示明显分化的低分化肿瘤的情况下。建议进行有限的诊断性检查，以尽可能多地保存组织用于分子检测。大多数肿瘤可以使用单一的腺癌标志物（如甲状腺转录因子1或粘蛋白）和单一的鳞状细胞标志物（如p40或p63）进行分类。形态学和特殊染色缺乏明确分化的癌被归类为NSCLC，未另行说明。未另行说明的腺癌标记物染色的癌归类为NSCLC，有利于腺癌，仅鳞状标记物染色的肿瘤归类为NSCLC，有利于鳞状细胞癌。每个机构都需要制定一个多学科的组织管理策略，以获得这些小样本和处理它们，不仅用于诊断，而且用于分子检测和评价对治疗的抗性标志物。
The new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification provides, for the first time, standardized terminology for lung cancer diagnosis in small biopsies and cytology; this was not primarily addressed by previous World Health Organization classifications. Until recently there have been no therapeutic implications to further classification of NSCLC, so little attention has been given to the distinction of adenocarcinoma and squamous cell carcinoma in small tissue samples. This situation has changed dramatically in recent years with the discovery of several therapeutic options that are available only to patients with adenocarcinoma or NSCLC, not otherwise specified, rather than squamous cell carcinoma. This includes recommendation for use of special stains as an aid to diagnosis, particularly in the setting of poorly differentiated tumors that do not show clear differentiation by routine light microscopy. A limited diagnostic workup is recommended to preserve as much tissue for molecular testing as possible. Most tumors can be classified using a single adenocarcinoma marker (eg, thyroid transcription factor 1 or mucin) and a single squamous marker (eg, p40 or p63). Carcinomas lacking clear differentiation by morphology and special stains are classified as NSCLC, not otherwise specified. Not otherwise specified carcinomas that stain with adenocarcinoma markers are classified as NSCLC, favor adenocarcinoma, and tumors that stain only with squamous markers are classified as NSCLC, favor squamous cell carcinoma. The need for every institution to develop a multidisciplinary tissue management strategy to obtain these small specimens and process them, not only for diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, is emphasized.