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Original Article|Articles in Press

Defining morphologic features of invasion in pulmonary non-mucinous adenocarcinoma with lepidic growth - A proposal by the IASLC Pathology Committee

Open AccessPublished:December 08, 2022DOI:https://doi.org/10.1016/j.jtho.2022.11.026
Defining morphologic features of invasion in pulmonary non-mucinous adenocarcinoma with lepidic growth - A proposal by the IASLC Pathology Committee
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      Abstract

      Background

      Since the 8th edition of UICC/AJCC TNM classification system the primary tumor pT stage is determined based on presence and size of the invasive components. The aim of this study was to identify histological features in tumors with lepidic growth pattern that may be used to establish criteria for distinguishing invasive from non-invasive areas.

      Materials and Methods

      A Delphi approach was used with two rounds of blinded anonymized analysis of resected non-mucinous lung adenocarcinoma cases with presumed invasive and non-invasive components, followed by one round of reviewer de-anonymized and unblinded review of cases with known outcomes. A digital pathology platform was used for measuring total tumor size and invasive tumor size.

      Results

      The mean coefficient of variation for measuring total tumor size and tumor invasive size was 6.9% (range 1.7-22.3%) and 54% (range 14.7-155%), respectively, with substantial variations in interpretation of the size and location of invasion among pathologists. Following the presentation of the results and further discussion among members at large of the IASLC Pathology Committee, extensive epithelial proliferation (EEP) in areas of collapsed lepidic growth pattern is recognized as a feature likely to be associated with invasive growth. EEP is characterized by multilayered luminal epithelial cell growth, usually with high grade cytological features in several alveolar spaces.

      Conclusion

      Collapsed alveoli and transition zones with EEP were identified by the Delphi process as morphologic features that were a source of interobserver variability. Definition criteria for collapse and EEP are proposed to improve reproducibility of invasion measurement.

      Article info

      Publication history

      Accepted: November 23, 2022
      Received in revised form: November 4, 2022
      Received: September 3, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflict of Interest Statement:

      None of the authors declared a conflict of interest.

      CRediT roles:

      Mary Beth Beasley, Alain Borczuk, Sanja Dacic, Keith M Kerr, Yuko Minami,

      Andrew G Nicholson, Masayuki Noguchi, Lynette Sholl, Ming-Sound Tsao, E. Thunnissen:

      Conceptualization;

      Mary Beth Beasley, Alain Borczuk, Sanja Dacic, Keith M Kerr, Yuko Minami, Andrew G Nicholson, Masayuki Noguchi, Lynette Sholl, Ming-Sound Tsao, E. Thunnissen, William D. Travis, Anja C. Roden, Jin-Haeng Chung, Akihiko Yoshira; Andre L. Moreira, Sylvie Lantuejoul, Giuseppe Pelosi, Claudia Poleri, David Hwang, Deepali Jain, Elisabeth Brambilla, Gang Chen, Johan Botling, Lukas Bubendorf, Mari Mino-Kenudson, Noriko Motoi, Teh Ying Chou, Mauro Papotti, Yasushi Yatabe, Wendy Cooper: Investigation

      Mary Beth Beasley, Alain Borczuk, Sanja Dacic, Keith M Kerr, Yuko Minami, Andrew G Nicholson, Masayuki Noguchi, Lynette Sholl, Ming-Sound Tsao, E. Thunnissen:

      Validation;

      B. Lissenberg-Witte, Alain Borczuk, Erik Thunnissen: Data curation; B. Lissenberg-Witte, Alain Borczuk, Erik Thunnissen: Formal analysis; Alain Borczuk, E. Thunnissen: Visualization; Mary Beth Beasley, Alain Borczuk, Sanja Dacic, Keith M Kerr, Yuko Minami, Andrew G Nicholson, Masayuki Noguchi, Lynette Sholl, Ming-Sound Tsao, E. Thunnissen:

      Roles/Writing - original draft; Mary Beth Beasley, Alain Borczuk, Sanja Dacic, Keith M Kerr, Yuko Minami, Andrew G Nicholson, Masayuki Noguchi, Lynette Sholl, Ming-Sound Tsao, E. Thunnissen

      John Le Quesne, William D. Travis, Anja C. Roden, Jin-Haeng Chung, Akihiko Yoshira, Andre L. Moreira, Sylvie Lantuejoul, Giuseppe Pelosi, Claudia Poleri, David Hwang, Deepali Jain, Elisabeth Brambilla, Gang Chen, Johan Botling, Lukas Bubendorf, Mari Mino-Kenudson, Noriko Motoi, Teh Ying Chou, Mauro Papotti, Yasushi Yatabe, Wendy Cooper: Writing - review & editing

      Identification

      DOI: https://doi.org/10.1016/j.jtho.2022.11.026

      Copyright

      © 2022 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

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