International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.
International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.
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DOI：
10.1097/jto.0b013e318206a221
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发表时间：
2011-02
期刊：
影响因子：
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通讯作者：
Yankelewitz D
中科院分区：
文献类型：
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作者：
Travis WD;Brambilla E;Noguchi M;Nicholson AG;Geisinger KR;Yatabe Y;Beer DG;Powell CA;Riely GJ;Van Schil PE;Garg K;Austin JH;Asamura H;Rusch VW;Hirsch FR;Scagliotti G;Mitsudomi T;Huber RM;Ishikawa Y;Jett J;Sanchez-Cespedes M;Sculier JP;Takahashi T;Tsuboi M;Vansteenkiste J;Wistuba I;Yang PC;Aberle D;Brambilla C;Flieder D;Franklin W;Gazdar A;Gould M;Hasleton P;Henderson D;Johnson B;Johnson D;Kerr K;Kuriyama K;Lee JS;Miller VA;Petersen I;Roggli V;Rosell R;Saijo N;Thunnissen E;Tsao M;Yankelewitz D
腺癌是肺癌最常见的组织学类型。为了解决肺腺癌的肿瘤学、分子生物学、病理学、放射学和外科学方面的进展，国际肺癌研究协会、美国胸科学会和欧洲呼吸学会发起了一项国际多学科分类。这种新的腺癌分类是需要提供统一的术语和诊断标准，特别是细支气管肺泡癌（BAC），小的非切除癌标本的整体方法，并为分子和免疫组化研究组织的多学科战略管理。由肿瘤学家/肺病学家、病理学家、放射学家、分子生物学家和胸外科医生组成的国际核心专家小组代表了所有三个学会。在美国胸科学会文件制定和实施委员会的指导下进行了系统评价。检索策略识别了11，368篇引文，其中312篇文章符合规定的合格标准，并检索进行全文审查。举行了一系列会议，讨论新分类的发展，制定建议，并编写当前的文件。根据建议、评估、发展和评价方法的等级，对关键问题的建议按证据的强度和质量进行分级。该分类涉及切除标本、小活检和细胞学。术语BAC和混合亚型腺癌不再使用。对于切除标本，引入了新的概念，如原位腺癌（AIS）和微创腺癌（MIA），用于纯鳞片状生长（AIS）或主要鳞片状生长伴≤ 5 mm浸润（MIA）的小孤立腺癌，以定义如果接受完全切除，将分别具有100%或接近100%的疾病特异性生存率的患者。AIS和MIA通常是非粘液性的，但很少是粘液性的。在使用全面的组织学亚型后，侵袭性腺癌按主要模式进行分类，其中包括鳞片型（以前大多数混合亚型肿瘤与非粘液性BAC）、腺泡型、乳头状型和实体型;微乳头型被添加为新的组织学亚型。变体包括侵袭性粘液腺癌（以前为粘液腺癌）、胶体腺癌、胎儿腺癌和肠腺癌。这种分类为小活检和细胞学标本提供了指导，因为大约70%的肺癌是在这种样本中诊断的。晚期疾病患者的非小细胞肺癌（NSCLC）应尽可能分为更具体的类型，如腺癌或鳞状细胞癌，原因如下：（1）腺癌或NSCLC（未另行说明）应检测表皮生长因子受体（EGFR）突变，因为这些突变的存在可预测对EGFR酪氨酸激酶抑制剂的反应性，（2）与鳞状细胞癌相比，腺癌组织学是培美曲塞治疗改善结局的强预测因子，（3）接受贝伐单抗治疗的鳞状细胞癌患者可能发生潜在危及生命的出血。如果仅根据光学显微镜检查无法对肿瘤进行分类，则应进行特殊研究，如免疫组织化学和/或粘蛋白染色，以进一步对肿瘤进行分类。应尽量减少使用术语NSCLC（未另行说明）。这种新的分类策略是基于诊断肺腺癌的多学科方法，包括临床，分子，放射学和手术问题，但它主要是基于组织学。该分类旨在支持临床实践、研究调查和临床试验。由于EGFR突变是EGFR酪氨酸激酶抑制剂治疗晚期肺腺癌的缓解和无进展生存期的有效预测标志物，因此我们建议对晚期腺癌患者进行EGFR突变检测。这对组织的战略管理有影响，特别是对于小活检和细胞学样本，以最大限度地提高可用于分子研究的高质量组织。对肿瘤、淋巴结和转移分期的潜在影响包括仅根据浸润性成分调整T因子的大小（1）病理学上在具有鳞屑区域的浸润性肿瘤中或（2）放射学上通过测量部分实性结节的实性成分。
Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.