Pulmonary Adenocarcinomas of Low Malignant Potential

腺癌 医学 过度诊断 全国肺筛查试验 病理 肿瘤科 癌症 肺癌 内科学 阶段(地层学) 放射科 肺癌筛查 生物 古生物学
作者
Ilyas Yambayev,Travis Sullivan,Kei Suzuki,Qing Zhao,Sara Higgins,Osman Yılmaz,Virginia R. Litle,Paulo César Moreira,Elliot L. Servais,Cameron T. Stock,Syed M. Quadri,Christina Williamson,Kimberly Rieger-Christ,Eric Burks
出处
期刊:The American Journal of Surgical Pathology [Ovid Technologies (Wolters Kluwer)]
卷期号:45 (4): 567-576 被引量:13
标识
DOI:10.1097/pas.0000000000001618
摘要

Lung cancer screening has improved mortality among high-risk smokers but has coincidentally detected a fraction of nonprogressive adenocarcinoma historically classified as bronchoalveolar carcinoma (BAC). In the National Lung Screening Trial (NLST) the majority of BAC—comprising 29% of computed tomography–detected stage I lung adenocarcinoma—were considered overdiagnosis after extended follow-up comparison with the control arm. In the current classification, adenocarcinoma in situ and minimally invasive adenocarcinoma have replaced BAC but together comprise only ∼5% of stage I lung adenocarcinoma. Lepidic and subsets of papillary and acinar adenocarcinoma also infrequently recur. We, therefore, propose criteria for low malignant potential (LMP) adenocarcinoma among nonmucinous adenocarcinoma measuring ≤3 cm in total, exhibiting ≥15% lepidic growth, and lacking nonpredominant high-grade patterns (≥10% cribriform, ≥5% micropapillary, ≥5% solid), >1 mitosis per 2 mm 2 , angiolymphatic or visceral pleural invasion, spread through air spaces or necrosis. We tested these criteria in a multi-institutional cohort of 328 invasive stage I (eighth edition) and in situ adenocarcinomas and observed 16% LMP and 7% adenocarcinoma in situ/minimally invasive adenocarcinoma which together (23%) approximated the frequency of overdiagnosed stage I BAC in the NLST. The LMP group had 100% disease-specific survival. The proposed LMP criteria, incorporating multiple histologic parameters, may be a clinically useful “low-grade” prognostic group. Validation of these criteria in additional retrospective cohorts and prospective screen-detected cohorts should be considered.
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