151
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
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152
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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153
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Li W, Cohen MB. TTF-1, napsin A and CDX2 co-expression in metastatic rectal adenocarcinoma to the lung. Cytopathology 2020; 32:146-148. [PMID: 32633432 DOI: 10.1111/cyt.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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154
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Li W, Niehaus AG, O’Neill SS. Immunohistochemistry Profile Predicts EGFR Mutation Status in Lung Adenocarcinoma. Int J Surg Pathol 2020; 28:502-506. [DOI: 10.1177/1066896920909427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Significant advances in targeted therapy have been made in recent years for patients with lung adenocarcinoma. These targeted therapies have made molecular testing of paramount importance to drive therapeutic decisions. Material for testing is often limited, particularly in cytology specimens and small core biopsies. A reliable screening tool is invaluable in triaging limited tissue and selection for epidermal growth factor receptor ( EGFR) mutation testing. We hypothesized that the immunohistochemistry (IHC) profile of lung adenocarcinoma predicts EGFR mutation status. In this retrospective study, we evaluated the thyroid transcription factor-1 (TTF-1)/napsin A IHC profile and EGFR mutation status in 339 lung adenocarcinomas at our academic institution. In our cohort, we found that 92.3% of cases were positive for TTF-1 and/or napsin A by IHC with an EGFR positivity rate of 17.3%. Importantly, 7.7% of the cases were dual TTF-1/napsin A negative, and none of these cases contained EGFR mutations. This finding supports the use of TTF-1 and napsin A IHC to identify cases where EGFR mutation status will be negative, thus preserving limited tissue for other ancillary testing.
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Affiliation(s)
- Wencheng Li
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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155
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Liam CK, Liam YS, Poh ME, Wong CK. Accuracy of lung cancer staging in the multidisciplinary team setting. Transl Lung Cancer Res 2020; 9:1654-1666. [PMID: 32953539 PMCID: PMC7481640 DOI: 10.21037/tlcr.2019.11.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Accurate staging of lung cancer is of utmost importance in determining the stage-appropriate treatment and prognosis. Imaging tests which include contrast-enhanced computed tomography (CT) examination of the chest to include the liver and adrenal glands and 18-fluoro-2 deoxyglucose positron emission tomography (PET)/CT scan facilitate the initial tumor node metastasis (TNM) staging of the disease and provide guidance on the optimal biopsy site and biopsy method. The diagnostic and staging approach should be tailored to the individual patient according to risk, benefit, patient preferences, and available expertise. Diagnosis and staging should preferably be accomplished with a single procedure or the least number of invasive procedures if more than one is needed. Ideally, centers managing lung cancer patients should have a multidisciplinary thoracic oncology board prescribing personalized evidence-based management tailored to each individual patient. Multidisciplinary team (MDT) meetings provide a platform for key experts from various disciplines to contribute specific advice on the management of each individual patient. As assessment of mediastinal lymph node involvement is an important component of lung cancer staging, optimal mediastinal staging can be achieved with a variety of techniques that can be discussed and performed by the various specialists in the MDT. Despite a relative paucity of quality evidence that MDT contributes to improvements in lung cancer survival outcomes, this approach has evolved to become the standard of care in many centers around the world. Thoracic MDT has resulted in more focused and timely investigations for histopathologic diagnosis and disease staging which translate into earlier treatment initiation. Moreover, there is increasing evidence that MDT care facilitates and allows access to investigations that lead to improved accuracy of tumor and nodal staging. However, there is still a paucity of evidence on the accuracy of lung cancer staging in the MDT setting.
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Affiliation(s)
- Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Sheng Liam
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mau-Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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156
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Yang SR, Schultheis AM, Yu H, Mandelker D, Ladanyi M, Büttner R. Precision medicine in non-small cell lung cancer: Current applications and future directions. Semin Cancer Biol 2020; 84:184-198. [PMID: 32730814 DOI: 10.1016/j.semcancer.2020.07.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
Advances in biomarkers, targeted therapies, and immuno-oncology have transformed the clinical management of patients with advanced NSCLC. For oncogene-driven tumors, there are highly effective targeted therapies against EGFR, ALK, ROS1, BRAF, TRK, RET, and MET. In addition, investigational therapies for KRAS, NRG1, and HER2 have shown promising results and may become standard-of-care in the near future. In parallel, immune-checkpoint therapy has emerged as an indispensable treatment modality, especially for patients lacking actionable oncogenic drivers. While PD-L1 expression has shown modest predictive utility, biomarkers for immune-checkpoint inhibition in NSCLC have remained elusive and represent an area of active investigation. Given the growing importance of biomarkers, optimal utilization of small tissue biopsies and alternative genotyping methods using circulating cell-free DNA have become increasingly integrated into clinical practice. In this review, we will summarize the current landscape and emerging trends in precision medicine for patients with advanced NSCLC with a special focus on predictive biomarker testing.
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Affiliation(s)
- Soo-Ryum Yang
- Memorial Sloan Kettering Cancer Center, Department of Pathology, United States
| | | | - Helena Yu
- Memorial Sloan Kettering Cancer Center, Department of Medicine, United States
| | - Diana Mandelker
- Memorial Sloan Kettering Cancer Center, Department of Pathology, United States
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, Department of Pathology, United States
| | - Reinhard Büttner
- University Hospital of Cologne, Department of Pathology, Germany.
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157
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Srebotnik Kirbiš I, Rodrigues Roque R, Bongiovanni M, Strojan Fležar M, Cochand-Priollet B. Immunocytochemistry practices in European cytopathology laboratories-Review of European Federation of Cytology Societies (EFCS) online survey results with best practice recommendations. Cancer Cytopathol 2020; 128:757-766. [PMID: 32598103 DOI: 10.1002/cncy.22311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/19/2020] [Accepted: 05/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Variability in preanalytical and analytical steps for immunocytochemistry (ICC) on cytology samples is poorly defined. The objective of this study was to evaluate current practices for ICC on cytology samples in European laboratories. METHODS A link to an online survey with 19 questions about ICC practices was distributed to cytology laboratories through national representatives in the European Federation of Cytology Societies. RESULTS In total, 245 laboratories responded to the survey by January 30, 2019. Cell blocks, cytospins, liquid-based cytology (LBC) preparations, and smears alone or in combination with other preparations were used for ICC in 38%, 22%, 21%, and 19% of laboratories, respectively. In general, various combinations of preparations were used for ICC in greater than one-half of laboratories (147 of 245; 60%), whereas only 1 specific type of cytology preparation was used in the remaining 98 of 245 laboratories (40%) laboratories. The majority of laboratories (217 of 226; 96%) performed ICC on automated platforms using protocols that were the same as those used for formalin-fixed, paraffin-embedded samples (238 of 527 laboratories; 45%), either optimized (138 of 527 laboratories; 26%) or optimized and validated (151 of 527 laboratories; 29%) for cytology preparations. Positive control slides, negative control slides, and external quality control were used in 174 of 223 (78%), 112 of 223 (50%), and 111 of 120 (50%) laboratories, respectively. Greater than 1000 ICC tests were performed yearly in 34% of laboratories (65 of 191; average, 1477 tests; median, 500 tests). CONCLUSIONS ICC is extensively performed in European laboratories using variously prepared cytology preparations on automated platforms, mostly without quality-assurance measures.
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Affiliation(s)
| | - Rúben Rodrigues Roque
- Anatomic Pathology Service, Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal
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158
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Jett JR, Kim ES. Response to Letter to the Editor. J Thorac Oncol 2020; 15:e110-e111. [PMID: 32536542 DOI: 10.1016/j.jtho.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- James R Jett
- Department of Medicine, National Jewish Health, Denver, Colorado.
| | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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159
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Kriegsmann M, Haag C, Weis CA, Steinbuss G, Warth A, Zgorzelski C, Muley T, Winter H, Eichhorn ME, Eichhorn F, Kriegsmann J, Christopolous P, Thomas M, Witzens-Harig M, Sinn P, von Winterfeld M, Heussel CP, Herth FJF, Klauschen F, Stenzinger A, Kriegsmann K. Deep Learning for the Classification of Small-Cell and Non-Small-Cell Lung Cancer. Cancers (Basel) 2020; 12:cancers12061604. [PMID: 32560475 PMCID: PMC7352768 DOI: 10.3390/cancers12061604] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Reliable entity subtyping is paramount for therapy stratification in lung cancer. Morphological evaluation remains the basis for entity subtyping and directs the application of additional methods such as immunohistochemistry (IHC). The decision of whether to perform IHC for subtyping is subjective, and access to IHC is not available worldwide. Thus, the application of additional methods to support morphological entity subtyping is desirable. Therefore, the ability of convolutional neuronal networks (CNNs) to classify the most common lung cancer subtypes, pulmonary adenocarcinoma (ADC), pulmonary squamous cell carcinoma (SqCC), and small-cell lung cancer (SCLC), was evaluated. A cohort of 80 ADC, 80 SqCC, 80 SCLC, and 30 skeletal muscle specimens was assembled; slides were scanned; tumor areas were annotated; image patches were extracted; and cases were randomly assigned to a training, validation or test set. Multiple CNN architectures (VGG16, InceptionV3, and InceptionResNetV2) were trained and optimized to classify the four entities. A quality control (QC) metric was established. An optimized InceptionV3 CNN architecture yielded the highest classification accuracy and was used for the classification of the test set. Image patch and patient-based CNN classification results were 95% and 100% in the test set after the application of strict QC. Misclassified cases mainly included ADC and SqCC. The QC metric identified cases that needed further IHC for definite entity subtyping. The study highlights the potential and limitations of CNN image classification models for tumor differentiation.
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Affiliation(s)
- Mark Kriegsmann
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Correspondence: (M.K.); (K.K.); Tel.: +49-6221-56-36930 (M.K.); +49-6221-56-37238 (K.K.)
| | - Christian Haag
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, 68782 Mannheim, Germany;
| | - Georg Steinbuss
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
| | - Arne Warth
- Institute of Pathology, Cytopathology, and Molecular Pathology, UEGP MVZ Gießen/Wetzlar/Limburg, 65549 Limburg, Germany;
| | - Christiane Zgorzelski
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Thomas Muley
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Martin E. Eichhorn
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Florian Eichhorn
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Joerg Kriegsmann
- Molecular Pathology Trier, 54296 Trier, Germany;
- Danube Private University Krems, 3500 Krems, Austria
| | - Petros Christopolous
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | | | - Peter Sinn
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Moritz von Winterfeld
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
| | - Claus Peter Heussel
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Thoraxklinik, Heidelberg University, 69120 Heidelberg, Germany
| | - Felix J. F. Herth
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University, 69126 Heidelberg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University, 69120 Heidelberg, Germany; (C.H.); (G.S.); (C.Z.); (P.S.); (M.v.W.); (A.S.)
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), 69120 Heidelberg, Germany; (T.M.); (H.W.); (M.E.E.); (F.E.); (P.C.); (M.T.); (C.P.H.); (F.J.F.H.)
| | - Katharina Kriegsmann
- Department Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany
- Correspondence: (M.K.); (K.K.); Tel.: +49-6221-56-36930 (M.K.); +49-6221-56-37238 (K.K.)
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160
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Radonic T, Duin S, Vos W, Kortman P, Zwinderman AH, Thunnissen E. Influence of preanalytical variables on performance of delta-like protein 3 (DLL3) predictive immunohistochemistry. Virchows Arch 2020; 478:293-300. [PMID: 32488689 PMCID: PMC7969697 DOI: 10.1007/s00428-020-02848-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
Abstract
DLL3 might become a predictive immunohistochemical marker in small cell carcinoma of the lung (SCLC). We investigated the influence of pre-analytical handling of samples on the performance of DLL3 immunohistochemistry (IHC) using DLL3 SP347 ready to use assay (Ventana). DLL3 positive cell lines were subjected to different experimental conditions mimicking the pre-analytical variation in daily clinical practice. Formalin fixation of 24 h led to the most optimal results of DLL3 IHC. Longstanding fixation in Cytolyt, methanol-based fixative for cytology samples, but also decalcification using a mix of formic- and hydrochloracid resulted in decreased DLL3 staining. Postponed staining of blanc slides for 3 months also decreased DLL3 IHC. Postponed fixation of the SCLC cell lines did not influence the performance of DLL3 IHC, although this might be different in the tissues than in the cell lines. In conclusion, different pre-analytical variables decrease the performance of DLL3 IHC. These findings are essential for implementing novel predictive immunohistochemical biomarkers in daily pathology practice.
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Affiliation(s)
- Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, De Boelelaan, 1117, Amsterdam, The Netherlands.
| | - S Duin
- Department of Pathology, Amsterdam University Medical Center, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - W Vos
- Department of Pathology, Amsterdam University Medical Center, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - P Kortman
- Department of Pathology, Amsterdam University Medical Center, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, De Boelelaan, 1117, Amsterdam, The Netherlands
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161
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Roy-Chowdhuri S. Immunocytochemistry of cytology specimens for predictive biomarkers in lung cancer. Transl Lung Cancer Res 2020; 9:898-905. [PMID: 32676355 PMCID: PMC7354113 DOI: 10.21037/tlcr.2019.12.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
With a growing number of predictive biomarkers that have emerged in non-small cell lung carcinoma (NSCLC), there has been a paradigm shift in the management of these patients. Of the various predictive biomarker testing methods, immunohistochemistry (IHC) is the most widely available, cost-effective, and commonly used methods. However, most predictive IHC assays are validated primarily on formalin-fixed paraffin-embedded (FFPE) histologic tissue samples and translating these assays to cytologic specimens requires additional and rigorous validation. This is part due to the lack of standardized processing protocols in cytology resulting in a variety of preanalytic variables that can impact the antigenicity of antibodies used for predictive biomarker testing. The review article discusses the various preanalytical and analytical factors that impact immunocytochemistry (ICC) in cytologic specimens and summarizes the current published literature on ALK, ROS1, PD-L1, and other predictive biomarker ICC in cytology.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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162
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Prognostic impact of mucin spread, tumor cell spread, and invasive size in invasive mucinous adenocarcinoma of the lung. Lung Cancer 2020; 146:50-57. [PMID: 32512273 DOI: 10.1016/j.lungcan.2020.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The pathological T descriptor of lung invasive mucinous adenocarcinoma (IMA) is currently defined according to mucin spread, whereas that of lung non-mucinous adenocarcinoma is defined according to invasive lesion. This study aimed to evaluate and compare the prognostic impact of mucin spread, tumor cell spread, and invasive lesion in patients with lung IMA. MATERIALS AND METHODS Twenty-seven patients with completely resected pT1-4N0M0 IMA were evaluated. The radiological size (RS), mucin spread size (MS), tumor cell spread size (TS), and invasive size (IS) of the primary tumors were determined. Cox proportional hazards models were used to estimate recurrence-free survival (RFS). Because the MS, TS, and IS may be mutually confounding factors, they were evaluated using separate multivariate models including potential prognostic factors identified as significant on univariate analyses. RESULTS The median postoperative follow-up time was 4.9 years. TS and IS were significantly smaller than RS by a median of 0.3 cm (p = 0.027) and 1.4 cm (p < 0.0001), whereas MS and RS were not significantly different (p > 0.999). Univariate analyses identified T descriptors defined by MS, TS, and IS as potentially negative prognostic factors, in addition to age >75 years and carcinoembryonic antigen >5 ng/mL. Multivariate analyses revealed that T factors defined by MS, TS, and IS were significant predictors of RFS (p < 0.0001, p = 0.0002, and p = 0.0067, respectively). CONCLUSION MS is a reasonable determinant of the pathological T descriptor of lung IMA. TS and IS are potential candidates, although they remain discordant with RS. If the TS or IS is to be considered a candidate for the pathological T descriptor of lung IMA, the discordance with RS should first be resolved. If IS is used to define pathological T factor, clear criteria for mucinous AIS/MIA with IMA features should be developed.
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163
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Sung S, Heymann JJ, Crapanzano JP, Moreira AL, Shu C, Bulman WA, Saqi A. Lung cancer cytology and small biopsy specimens: diagnosis, predictive biomarker testing, acquisition, triage, and management. J Am Soc Cytopathol 2020; 9:332-345. [PMID: 32591241 DOI: 10.1016/j.jasc.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
In the 21st century, there has been a dramatic shift in the management of advanced-stage lung carcinoma, and this has coincided with an increasing use of minimally invasive tissue acquisition methods. Both have had significant downstream effects on cytology and small biopsy specimens. Current treatments require morphologic, immunohistochemical, and/or genotypical subtyping of non-small cell lung carcinoma. To meet these objectives, standardized classification of cytology and small specimen diagnoses, immunohistochemical algorithms, and predictive biomarker testing guidelines have been developed. This review provides an overview of current classification, biomarker testing, methods of small specimen acquisition and triage, clinical management strategies, and emerging technologies.
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Affiliation(s)
- Simon Sung
- Columbia University Medical Center, Department of Pathology & Cell Biology, New York, New York.
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | - John P Crapanzano
- Columbia University Medical Center, Department of Pathology & Cell Biology, New York, New York
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Catherine Shu
- Department of Medicine, Hematology & Oncology, Columbia University Medical Center, New York, New York
| | - William A Bulman
- Department of Medicine, Pulmonary, Columbia University Medical Center, New York, New York
| | - Anjali Saqi
- Columbia University Medical Center, Department of Pathology & Cell Biology, New York, New York
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Frost N, Zhamurashvili T, von Laffert M, Klauschen F, Ruwwe-Glösenkamp C, Raspe M, Brunn M, Ochsenreither S, Temmesfeld-Wollbrück B, Suttorp N, Grohé C, Witzenrath M. Pemetrexed-Based Chemotherapy Is Inferior to Pemetrexed-Free Regimens in Thyroid Transcription Factor 1 (TTF-1)-Negative, EGFR/ALK-Negative Lung Adenocarcinoma: A Propensity Score Matched Pairs Analysis. Clin Lung Cancer 2020; 21:e607-e621. [PMID: 32620471 DOI: 10.1016/j.cllc.2020.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/02/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Thyroid transcription factor 1 (TTF-1) is a prognostic biomarker in lung adenocarcinoma; however, TTF-1-positive patients also display more favorable factors like actionable target mutations. In contrast, TTF-1-negative cancer is a poorly described entity. We performed a retrospective study to characterize a TTF-1-negative phenotype and to evaluate outcome depending on the chemotherapy regimen applied in the EGFR/ALK-negative population. PATIENTS AND METHODS Phenotypic traits were analyzed in 741 patients with evaluable TTF-1 expression status, among them 529 patients with platinum-based first-line chemotherapy, with disease diagnosed between 2009 and 2016 at a tertiary referral university hospital. The influence of TTF-1 and several cofactors on progression-free survival and overall survival (OS) were analyzed using a 1:1 propensity score matching model, depending on the platinum doublet chemotherapy's incorporating pemetrexed or not, with subsequent Cox regression. RESULTS TTF-1 negativity implied a distinct cancer phenotype with the predominance of male sex, worse Eastern Cooperative Oncology Group performance status, greater metastatic burden at primary diagnosis, and more adrenal gland metastases. These patients had improved progression-free survival (hazard ratio, 0.42; P = .001) and OS (hazard ratio, 0.40; P < .001) when gemcitabine-, taxane-, or vinorelbine-based regimens were provided instead of pemetrexed. None of the regimens was superior in TTF-1-positive patients with regard to OS. Overall, TTF-1 expression was strongly prognostic with a substantial increase in progression-free survival (hazard ratio, 0.54; P < .001) and OS (hazard ratio, 0.53; P < .001). CONCLUSION TTF-1 negativity is associated with a distinct cancer phenotype. Incorporation of this biomarker may be helpful when choosing an appropriate therapy regimen.
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Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Tamar Zhamurashvili
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maximilian von Laffert
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frederick Klauschen
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Raspe
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Sebastian Ochsenreither
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrück
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Division of Pulmonary Inflammation, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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165
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The International Association for the Study of Lung Cancer Global Survey on Molecular Testing in Lung Cancer. J Thorac Oncol 2020; 15:1434-1448. [PMID: 32445813 DOI: 10.1016/j.jtho.2020.05.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Access to targeted therapies for lung cancer depends on the accurate identification of patients' biomarkers through molecular testing. The International Association for the Study of Lung Cancer (IASLC) conducted an international survey to evaluate perceptions on current practice and barriers to implementation of molecular testing. METHODS We distributed the survey to IASLC members and other health care professionals around the world. The survey included a seven-question introduction for all respondents, who then answered according to one of three tracks: (1) requesting tests and treating patients, (2) performing and interpreting assays, or (3) tissue acquisition. Barriers to implementing molecular testing were provided in free-response fields. The chi-square test was used for regional comparisons. RESULTS A total of 2537 respondents from 102 countries participated. Most respondents who test and treat patients believe that less than 50% of patients with lung cancer in their country receive molecular testing, but reported higher rates within their own practice. Although many results varied by region, the five most frequent barriers cited in all regions were cost, quality and standards, access, awareness, and turnaround time. Many respondents expressed dissatisfaction with the current state of molecular testing for lung cancer, including 41% of those performing and interpreting assays. Issues identified included trouble understanding results (37%) and the quality of the samples (23% reported >10% rejection rate). Despite concerns regarding the quality of testing, 47% in the performing and interpreting track stated there is no policy or strategy to improve quality in their country. In addition, 33% of respondents who request tests and treat patients were unaware of the most recent College of American Pathologists, IASLC, and Association for Molecular Pathology guidelines for molecular testing. CONCLUSIONS Adoption of molecular testing for lung cancer is relatively low across the world. Barriers include cost, access, quality, turnaround time, and lack of awareness.
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Aizawa H, Karasaki T, Nagayama K, Shinozaki-Ushiku A, Aburatani H, Mano H, Nakajima J. Clinical Application of Next-generation Sequencing for the Diagnosis of Lung Squamous Cell Carcinoma: Is It Primary or Secondary? Intern Med 2020; 59:1299-1302. [PMID: 32051379 PMCID: PMC7303454 DOI: 10.2169/internalmedicine.3682-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
An 80-year-old man with a history of cutaneous squamous cell carcinoma (SCC) was referred to our department for a solitary lung nodule. The nodule was surgically resected and diagnosed as SCC. Because the lung lesion and a previous skin lesion showed similar histological findings, the origin of the lung tumor was uncertain. Next-generation sequencing using a targeted driver oncogene panel was applied for the further examination. The lung lesion was diagnosed as primary lung SCC, as the two tumors possessed distinct somatic mutations in TP53. Recent advances in clinical sequencing have enabled us to obtain an accurate diagnosis in pathologically challenging cases.
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Affiliation(s)
- Hiroaki Aizawa
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Japan
| | - Takahiro Karasaki
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, The University of Tokyo Graduate School of Medicine, Japan
| | - Hiroyuki Aburatani
- Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Japan
| | - Hiroyuki Mano
- Division of Cellular Signaling, National Cancer Center Research Institute, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Japan
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Wang S, Zhang J, Meng FJ, Yan YJ, Wang B, Guan ZY. Combination of pembrolizumab and 125I attenuates the aggressiveness of non-small cell lung cancer. Oncol Lett 2020; 19:4142-4150. [PMID: 32382353 DOI: 10.3892/ol.2020.11508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/14/2019] [Indexed: 11/06/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-associated mortality. Therapies targeting programmed cell death 1 ligand 1 (PD1L1) have promising effects on NSCLC. However, resistance to targeted therapy has become the main problem and the underling molecular mechanism remains unclear. In the present study, the expression of PD1L1 in NSCLC was determined and the association with clinicopathological characteristics was analyzed. A combination therapy was also constructed, including pembrolizumab (Pem) and iodine-125 (125I), which represented an efficient strategy for the treatment of NSCLC. The expression of PD1L1 was upregulated in NSCLC tissues and positively correlated with the Ki-67 index, pathological subtypes and risk stages. A higher level of PD1L1 expression was associated with poorer survival in patients with NSCLC, which could be used as a prognostic indicator. When NSCLC cells were cultured in the presence of Pem and 125I seeds, the combination treatment significantly abrogated the tumor proliferation and aggressiveness through the inhibition of matrix metalloproteinase-2 and -9 secretion. Flow cytometry analysis revealed pembrolizumab combined with 125I contributed to a higher rate of apoptosis and cell cycle arrest, indicating that the combination treatment improved the resistance to immunotherapy. Furthermore, the associated molecular mechanism was the dysregulation of ADAM metallopeptidase domain 17. The findings from the present study revealed that PD1L1 could be used as a predictive biomarker, and the application of combination treatment of pembrolizumab and 125I showed promising effects on NSCLC.
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Affiliation(s)
- Shuo Wang
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Jun Zhang
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Fan-Jie Meng
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Yi-Jie Yan
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Bin Wang
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Zhi-Yu Guan
- Department of Thoracic Surgery, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
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168
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Sung S, Shirazi M, Shu CA, Crapanzano JP, Saqi A. Pulmonary small cell carcinoma: Review, common and uncommon differentials, genomics and management. Diagn Cytopathol 2020; 48:790-803. [PMID: 32348027 DOI: 10.1002/dc.24449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/20/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. It is divided into sub-categories based upon morphology, immunostaining pattern, biology, molecular profile, and/or treatment options. Up until the early 2000s when driver mutations with targeted therapies were identified in a subset of adenocarcinomas, the most critical distinction of lung carcinomas was driven by differences in treatment between small cell carcinoma (SCC) and nonsmall cell lung carcinoma (NSCLC). The distinction between SCC and NSCLC remains critical in the 21st century for management, especially for advanced stage cancer. In the vast majority of cases, morphological features are sufficient to separate SCC from other types of lung cancers. In some instances, however, cytomorphological features and immunohistochemical overlap with other tumors, limited sample availability, and/or crush artifact pose diagnostic challenges. The aim of this review is to highlight salient features of SCC and ancillary studies to distinguish it from common and uncommon potential mimickers, as well as provide updates in genomics and management.
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Affiliation(s)
- Simon Sung
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Maryam Shirazi
- Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Catherine A Shu
- Columbia University Medical Center, Department of Medicine, Hematology & Oncology, New York, New York, USA
| | - John P Crapanzano
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Anjali Saqi
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
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169
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Liam CK, Mallawathantri S, Fong KM. Is tissue still the issue in detecting molecular alterations in lung cancer? Respirology 2020; 25:933-943. [PMID: 32335992 DOI: 10.1111/resp.13823] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/23/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Molecular biomarker testing of advanced-stage NSCLC is now considered standard of care and part of the diagnostic algorithm to identify subsets of patients for molecular-targeted treatment. Tumour tissue biopsy is essential for an accurate initial diagnosis, determination of the histological subtype and for molecular testing. With the increasing use of small biopsies and cytological specimens for diagnosis and the need to identify an increasing number of predictive biomarkers, proper management of the limited amount of sampling materials available is important. Many patients with advanced NSCLC do not have enough tissue for molecular testing and/or do not have a biopsy-amenable lesion and/or do not want to go through a repeat biopsy given the potential risks. Molecular testing can be difficult or impossible if the sparse material from very small biopsy specimens has already been exhausted for routine diagnostic purposes. A limited diagnostic workup is recommended to preserve sufficient tissue for biomarker testing. In addition, tumour biopsies are limited by tumour heterogeneity, particularly in the setting of disease resistance, and thus may yield false-negative results. Hence, there have been considerable efforts to determine if liquid biopsy in which molecular alterations can be non-invasively identified in plasma cell-free ctDNA, a potential surrogate for the entire tumour genome, can overcome the issues with tissue biopsies and replace the need for the latter.
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Affiliation(s)
- Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Kwun M Fong
- Thoracic Medicine, The Prince Charles Hospital, The University of Queensland Thoracic Research Centre at TPCH, Brisbane, QLD, Australia
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170
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Hu Z, Zou X, Qin S, Li Y, Wang H, Yu H, Sun S, Wu X, Wang J, Chang J. Hormone receptor expression correlates with EGFR gene mutation in lung cancer in patients with simultaneous primary breast cancer. Transl Lung Cancer Res 2020; 9:325-336. [PMID: 32420072 PMCID: PMC7225161 DOI: 10.21037/tlcr-20-513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The coexistence of double primaries of lung cancer (LC) and breast cancer (BC) are not uncommon in women, but there has been limited research conducted of their molecular association. To decipher the internal pathogenesis of LC in patients with concurrent BC and LC, this study explored the clinical factors and relationship between hormone receptor (HR) expression and epidermal growth factor receptor (EGFR) gene mutation. Methods The clinicopathological characteristics of 400 female patients clinically diagnosed with double primary LC and BC at Fudan University Shanghai Cancer Center were collected. Pathological discrimination was performed to further confirm the double primaries in patients with available tissues. LC samples were then examined to detect EGFR gene mutation status by PCR-based assays and HR expression by immunohistochemistry (IHC). As a control cohort, the characteristics of 114 consecutive patients with LC only were compared with the double-primary patient group. Results A total of 169 patients were pathologically confirmed with simultaneous LC and BC between January 2010 and October 2018. The dominant LC subtype was adenocarcinoma (ADC) (95.1%), and invasive ductal carcinoma (IDC) was the main BC subtype (71.0%). Synchronous and metachronous double primary BC-LC cases accounted for 39.1% and 60.9% of the patients, respectively. The absence of family cancer history was associated with a shorter interval between the two primary cancer diagnoses. Among 64 patients with EGFR mutations, 34.4% had HR-positive LC tissue, compared with 0/24 (0%) of those with EGFR wild-type LC (P<0.001). All of the patients with positive HR expression harbored an activating EGFR mutation (n=22); however, no correlation was observed in the control cohort. Conclusions Double primary BC-LC patients have distinctive clinicopathological features compared to those with LC only. The expression of HRs is significantly correlated with EGFR mutation status of LC tissues.
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Affiliation(s)
- Zhihuang Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
| | - Xuan Zou
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shanshan Qin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Center for Tumor Diagnosis and Therapy, Jinshan Hospital of Fudan University, Shanghai 201508, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Huijie Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hui Yu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Si Sun
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xianghua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
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Passiglia F, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, Franchina T, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Novello S. Diagnosis and treatment of early and locally advanced non-small-cell lung cancer: The 2019 AIOM (Italian Association of Medical Oncology) clinical practice guidelines. Crit Rev Oncol Hematol 2020; 148:102862. [PMID: 32062311 DOI: 10.1016/j.critrevonc.2019.102862] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022] Open
Abstract
The Italian Association of Medical Oncology (AIOM) has developed clinical practice guidelines for the diagnosis and treatment of patients with early and locally advanced non-small cell lung cancer. In the current paper a panel of AIOM experts in the field of thoracic malignancies discussed these topics, analyzing available scientific evidences, with the final aim of providing a summary of clinical recommendations, which may guide physicians in their current practice.
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Affiliation(s)
- F Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - L Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - F Facchinetti
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - R Ferrara
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - T Franchina
- Department of Human Pathology "G. Barresi", University of Messina, Italy
| | - U Malapelle
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - J Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy, Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - S Ramella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - G Rossi
- Pathologic Anatomy, Azienda USL della Romagna, S. Maria delle Croci Hospital of Ravenna and Degli Infermi Hospital of Rimini, Italy
| | - R Trisolini
- Interventional Pulmonology Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy.
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172
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Gao J, Ren Y, Guo H, Mao R, Xie H, Su H, She Y, Deng J, Yang M, Han B, Zhang Y, Li J, Xie D, Chen C. A new method for predicting survival in stage I non-small cell lung cancer patients: nomogram based on macrophage immunoscore, TNM stage and lymphocyte-to-monocyte ratio. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:470. [PMID: 32395514 PMCID: PMC7210133 DOI: 10.21037/atm.2020.03.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The prognosis of patients with stage I non-small cell lung cancer (NSCLC) is often uncertain. This study aims to investigate a new prognostic tool to classify stage I NSCLC patients more accurately. Methods CD68 and CD163 macrophages were quantified by immunohistochemical analyses of the center of the tumor and the invasive margin of the 339 tumors, which were used to construct the macrophage immunoscore (MI). Cox proportional hazards models determined the effects of multiple factors on disease-free survival (DFS) and overall survival (OS). One nomogram was developed to predict DFS and OS of stage I patients. Results The multivariate Cox analysis identified MI (P<0.001), lymphocyte-to-monocyte ratio (LMR, P=0.006), and TNM stage (P=0.046) as independent prognostic factors for DFS. Compared with MI, TNM stage, and LMR alone, the nomogram improved the prediction accuracy of both DFS and OS in terms of the Harrell concordance index in the training cohort (0.812, P<0.001 for DFS; 0.810, P<0.001 for OS) and the external validation cohort (0.796, P<0.001 for DFS; 0.791, P<0.001 for OS). In addition, net reclassification (Nomogram vs. TNM-stage, P<0.001 for DFS and OS) and the integrated discrimination (Nomogram vs. TNM stage, P<0.001 for DFS and OS) also validated this improvement. Conclusions The immunoscore-based prognostic nomogram could effectively predict DFS and OS of stage I NSCLC patients and enhance the predictive value of the TNM stage system.
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Affiliation(s)
- Jiani Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Haoyue Guo
- School of Medicine, Tongji University, Shanghai 200092, China
| | - Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Minglei Yang
- Department of Thoracic Surgery, Hwa Mei Hospital, The University of Chinese Academy of Sciences, Ningbo 315010, China
| | - Biao Han
- Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou 730050, China
| | - Yu Zhang
- Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou 730050, China
| | - Jian Li
- Department of Thoracic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi 510530, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China
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Abstract
BACKGROUND In addition to histological examinations, cytological samples are also being evaluated with increasing frequency for the diagnosis of lung carcinoma. OBJECTIVES Possible applications of and techniques for cytological examinations are presented. Typical morphologies of primary lung cancer and metastatic disease are shown. MATERIAL AND METHODS Samples were obtained during bronchoscopy, serous effusion fluid, and fine-needle aspiration cytology. Special technical features of the cytological samples are discussed. Cytomorphology of pulmonary adenocarcinoma, squamous-cell carcinoma, and small-cell lung carcinoma are shown. RESULTS There are clear-cut diagnostic criteria for the main subtypes of primary lung carcinoma. CONCLUSIONS Cytological examination is a valuable addition to histology for lung carcinoma diagnostics.
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174
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Wagner BJ, Buettner R. [Immunohistochemical and molecular pathological diagnosis of lung carcinoma]. DER PATHOLOGE 2020; 41:3-13. [PMID: 31932944 DOI: 10.1007/s00292-019-00732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The therapy of lung cancer has revolutionarily changed within the last 15 years. The prognosis of patients has dramatically improved due to targeted therapies, for instance tyrosine kinase inhibitors (TKI). Current recruiting studies are testing new MET-, KRAS-, ROS1-, RET- and NTRK-inhibitors. The first clinical data are promising, emphasizing that it remains a future challenge for pathologists and oncologists to keep an eye on all facets of therapy options. Today, precise lung cancer classification via immunohistochemistry and molecular pathology is crucial for the therapy and prognosis of patients. Further, new biopsy technologies lead to very small tumor tissue samples and cytological samples of high diagnostic quality. Therefore, the complexity of diagnosis needs a strategic procedure to minimize loss of tissue material. This assay gives an overview of efficient and target-orientated diagnostic procedures in consideration of current clinical trials.
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Affiliation(s)
- Britta Janina Wagner
- Institut für Pathologie, Universitätsklinikum und Centrum für Integrierte Onkologie (CIO) Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Reinhard Buettner
- Institut für Pathologie, Universitätsklinikum und Centrum für Integrierte Onkologie (CIO) Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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175
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Bhargava A, Mishra DK, Tiwari R, Lohiya NK, Goryacheva IY, Mishra PK. Immune cell engineering: opportunities in lung cancer therapeutics. Drug Deliv Transl Res 2020; 10:1203-1227. [PMID: 32172351 DOI: 10.1007/s13346-020-00719-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Engineered immune cells offer a prime therapeutic alternate for some aggressive and frequently occurring malignancies like lung cancer. These therapies were reported to result in tumor regression and overall improvement in patient survival. However, studies also suggest that the presence of cancer cell-induced immune-suppressive microenvironment, off-target toxicity, and difficulty in concurrent imaging are some prime impendent in the success of these approaches. The present article reviews the need and significance of the currently available immune cell-based strategies for lung cancer therapeutics. It also showcases the utility of incorporating nanoengineered strategies and details the available formulations of nanocarriers. In last, it briefly discussed the existing methods for nanoparticle fuctionalization and challenges in translating basic research to the clinics. Graphical Abstract.
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Affiliation(s)
- Arpit Bhargava
- Department of Molecular Biology, ICMR-National Institute for Research in Environmental Health, Kamla Nehru Hospital,, Building (Gandhi Medical College Campus), Bhopal, Madhya Pradesh, 462001, India
| | | | - Rajnarayan Tiwari
- Department of Molecular Biology, ICMR-National Institute for Research in Environmental Health, Kamla Nehru Hospital,, Building (Gandhi Medical College Campus), Bhopal, Madhya Pradesh, 462001, India
| | | | - Irina Yu Goryacheva
- Department of General and Inorganic Chemistry, Saratov State University, Saratov, Russian Federation
| | - Pradyumna Kumar Mishra
- Department of Molecular Biology, ICMR-National Institute for Research in Environmental Health, Kamla Nehru Hospital,, Building (Gandhi Medical College Campus), Bhopal, Madhya Pradesh, 462001, India.
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176
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Singh PK, Shrestha DK, Singh N, Gupta N. Extensive-disease small cell lung cancer, multiple relapses, five lines of therapy and more than 10-year survival. BMJ Case Rep 2020; 13:13/2/e232607. [PMID: 32111707 DOI: 10.1136/bcr-2019-232607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Small cell lung cancer (SCLC) accounts for nearly 18% of lung cancer cases. Most of the patients of SCLC are not surgical candidates, due to advanced stage at presentation hence only viable options are chemotherapy and radiotherapy. Long-term survival in SCLC is extremely rare due to relapses and comorbidities. Ten-year survival has never been reported in cases with extensive disease at presentation and history of relapses. Here we are describing a case of extensive disease SCLC who has survived multiple relapses and has received five lines of systemic therapy apart from radiation and palliative care. This case emphasises on the need of active and strict disease surveillance at each follow-up.
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Affiliation(s)
- Pawan Kumar Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepa Kumari Shrestha
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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177
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Passiglia F, Pilotto S, Facchinetti F, Bertolaccini L, Del Re M, Ferrara R, Franchina T, Malapelle U, Menis J, Passaro A, Ramella S, Rossi G, Trisolini R, Novello S. Treatment of advanced non-small-cell lung cancer: The 2019 AIOM (Italian Association of Medical Oncology) clinical practice guidelines. Crit Rev Oncol Hematol 2020; 146:102858. [PMID: 31918343 DOI: 10.1016/j.critrevonc.2019.102858] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023] Open
Abstract
The Italian Association of Medical Oncology (AIOM) has developed clinical practice guidelines for the treatment of patients with advanced non-small cell lung cancer (NSCLC). In the current paper a panel of AIOM experts in the field of thoracic malignancies discussed the available scientific evidences, with the final aim of providing a summary of clinical recommendations, which may guide physicians in their current practice.
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Affiliation(s)
- F Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy
| | - S Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - F Facchinetti
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - L Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - R Ferrara
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - T Franchina
- Department of Human Pathology "G. Barresi", University of Messina, Italy
| | - U Malapelle
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - J Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Ramella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - G Rossi
- Pathologic Anatomy, Azienda USL della Romagna, S. Maria delle Croci Hospital of Ravenna and Degli Infermi Hospital of Rimini, Italy
| | - R Trisolini
- Interventional Pulmonology Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy.
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178
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Abstract
Lung cancer can be diagnosed based on histologic biopsy or cytologic specimens. The 2015 World Health Organization Classification of Lung Tumors addressed the diagnosis of lung cancer in resection specimens and in small biopsies and cytology specimens. For these small specimens, diagnostic terms and criteria are recommended. Targetable mutations such as EGFR and ALK rearrangements emphasize the importance of managing these small specimens for molecular testing.
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Affiliation(s)
- William D Travis
- Thoracic Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, Room A525, 1275 York Avenue, New York, NY 10065, USA.
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179
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Sahay A, Kumar R, Janu A, Prabhash K. ALK1 Gene Rearranged Pulmonary Sarcomatoid Carcinoma Masquerading as Tuberculosis in a Young Male. Turk Patoloji Derg 2020; 1:71-77. [PMID: 32149365 PMCID: PMC10508925 DOI: 10.5146/tjpath.2020.01481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/15/2020] [Indexed: 11/18/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma is rare, with limited treatment options and poor prognosis. In contrast to other non small cell lung carcinomas, not much is known about its molecular biology. In an endemic country like India, lung cancer is often masked by tuberculosis and presents in advanced stages. We report here an unusual case of pulmonary sarcomatoid carcinoma, in a young non-smoker male, who had co-existent tuberculosis masking and delaying the diagnosis of malignancy. On molecular study, the tumor showed ALK gene rearrangement, both by immunohistochemistry and fluorescence in-situ hybridization, which has been reported only twice previously. Presence of ALK gene rearrangements in sarcomatoid carcinoma has significant therapeutic implications and potential for altering the prognosis of this fatal disease. Hence we recommend performing ALK gene rearrangement analysis in all cases of sarcomatoid lung carcinomas. The report discusses the diagnostic approach and provides insight into the molecular pathogenesis of this exceedingly rare malignancy.
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Affiliation(s)
- Ayushi Sahay
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
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180
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Skov BG, Rørvig SB, Jensen THL, Skov T. The prevalence of programmed death ligand-1 (PD-L1) expression in non-small cell lung cancer in an unselected, consecutive population. Mod Pathol 2020; 33:109-117. [PMID: 31383957 DOI: 10.1038/s41379-019-0339-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/09/2022]
Abstract
Little is known about prevalence of PD-L1 expression in tumor cells of unselected patients with all stages of non-small cell lung cancer. The objective of this study is to assess the prevalence of PD-L1 positivity in patients with non-small cell lung cancer, to analyze the association between PD-L1 positivity and patients' clinicopathological characteristics, and to assess the use of immune-oncologic treatment in eligible patients. All non-small cell lung cancer patients diagnosed in a 10-month period in an unselected population of 1.7 million Caucasian inhabitants were evaluated with the PD-L1 IHC 22C3 pharmDx kit. A total of 819 patients were diagnosed with non-small cell lung cancer. Samples analyzable for PD-L1 expression were obtained from 97% of patients. In a multivariate analysis with cut-off at tumor proportion score ≥50%, lower stage was associated with lower prevalence of PD-L1 positivity with an odds ratio of 0.31 for stage I vs. stage IV. A significant difference in PD-L1 expression between squamous-cell carcinoma and adenocarcinoma was observed with odds ratio for adenocarcinoma 1.8. With cut-off tumor proportion score ≥1%, attenuated effects of the same direction were seen. For neither cut-off did type and location of material used for PD-L1 analysis, age, sex, smoking history, or performance status have statistically significant impact on the PD-L1 expression. Fifty four percent of the patients who were eligible for immune-oncologic treatment were actually treated in first-line with pembrolizumab monotherapy. In conclusion, 97% of the patients had material analyzable for PD-L1. If a patient in need of immuno-oncologic treatment has shifted stage, a negative or low positive PD-L1 test performed on a biopsy taken in a lower stage might not mirror the PD-L1 expression in the new metastatic lesion. Therefore, a re-biopsy should be considered.
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Affiliation(s)
| | - Sara Bird Rørvig
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
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181
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Nicholson AG, Sauter JL, Nowak AK, Kindler HL, Gill RR, Remy-Jardin M, Armato SG, Fernandez-Cuesta L, Bueno R, Alcala N, Foll M, Pass H, Attanoos R, Baas P, Beasley MB, Brcic L, Butnor KJ, Chirieac LR, Churg A, Courtiol P, Dacic S, De Perrot M, Frauenfelder T, Gibbs A, Hirsch FR, Hiroshima K, Husain A, Klebe S, Lantuejoul S, Moreira A, Opitz I, Perol M, Roden A, Roggli V, Scherpereel A, Tirode F, Tazelaar H, Travis WD, Tsao MS, van Schil P, Vignaud JM, Weynand B, Lang-Lazdunski L, Cree I, Rusch VW, Girard N, Galateau-Salle F. EURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach. J Thorac Oncol 2020; 15:29-49. [DOI: 10.1016/j.jtho.2019.08.2506] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
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182
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Guo R, Tian Y, Zhang N, Huang H, Huang Y, Yang J. Use of dual-marker staining to differentiate between lung squamous cell carcinoma and adenocarcinoma. J Int Med Res 2019; 48:300060519893867. [PMID: 31880186 PMCID: PMC7645362 DOI: 10.1177/0300060519893867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the value of dual-marker immunostaining for detecting p40 and napsin A, and cytokeratin 5/6 (CK5/6) and thyroid transcription factor 1 (TTF1) in single sections of lung cancer tissue, for differentiating between lung squamous cell carcinoma and adenocarcinoma. METHODS Lung cancer tissue sections from 58 patients were stained by dual-marker immunostaining using a mixtures of anti-p40 and anti-napsin A, and anti-CK5/6 and anti-TTF1 primary antibodies. Sections stained with single markers were used as controls. Nuclear or cytoplasmic staining was considered as indicating positive p40 or napsin A expression, respectively, and cytoplasmic or nuclear staining was considered as indicating positive CK5/6 or TTF1 expression, respectively. RESULTS p40/napsin A and CK5/6/TTF1 dual-marker staining showed high sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of squamous cell carcinoma and adenocarcinoma respectively. There were no differences in marker expression between dual-marker and single-marker staining. CONCLUSIONS Dual-marker immunostaining is a relatively easy, time- and cost-conserving staining method for detecting two markers in a single section using one procedure and one chromogen. p40 and napsin A, and CK5/6 and TTF1 dual-marker staining were suitable for the differential diagnosis of lung squamous cell carcinoma and adenocarcinoma.
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Affiliation(s)
- Rui Guo
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Yi Tian
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Na Zhang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Hong Huang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Ying Huang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Jun Yang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
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183
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Baldovini C, Rossi G, Ciarrocchi A. Approaches to Tumor Classification in Pulmonary Sarcomatoid Carcinoma. LUNG CANCER-TARGETS AND THERAPY 2019; 10:131-149. [PMID: 31824199 PMCID: PMC6901065 DOI: 10.2147/lctt.s186779] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a heterogeneous category of primary lung cancer accounting from 0.3% to 3% of all primary lung malignancies. According to the most recent 2015 World Health Organization (WHO) classification, PSC includes several different variants of malignant epithelial tumors (carcinomas) histologically mimicking sarcomas showing or entirely lacking a conventional component of non-small cell lung cancer (NSCLC). Thus, this rare subheading of lung neoplasms includes pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, pulmonary blastoma, and carcinosarcoma. A diagnosis of PSC may be suspected on small biopsy or cytology, but commonly requires a surgical resection to reach a conclusive definition. The majority of patients with PSC consists of elderly, smoking men with a large, peripheral mass characterized by well-defined margins. However, presentation with a central, polypoid endobronchial lesion is well-documented, particularly in pleomorphic carcinoma and carcinosarcoma showing a squamous cell carcinoma component. As expected, PSC may pose diagnostic problems and immunohistochemistry is largely used when pathologists deal these tumors in routine practice. Indeed, PSC tends to overexpress molecules associated with the epithelial-to-mesenchymal transition, such as vimentin, but the panel of immunostains also includes epithelial markers (cytokeratins, EMA), TTF-1, p40 and negative markers (e.g., melanocytic, mesothelial and sarcoma-related primary antibodies). Although rare, PSC has increased their interest among oncologist community for different reasons: a. identification of the epithelial-to-mesenchymal phenomenon as a major mechanism of secondary resistance to tyrosine kinase inhibitors; b. over-expression of PD-L1 and effective treatment with immunotherapy; c. identification of c-MET exon 14 skipping mutation representing an effective target to crizotinib and other specific inhibitors. In this review, the feasibility of the diagnosis of PSC, its differential diagnosis and novel molecular findings characterizing this group of lung tumor are discussed.
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Affiliation(s)
- Chiara Baldovini
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Giulio Rossi
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia 42123, Italy
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184
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Domagala-Kulawik J. New Frontiers for Molecular Pathology. Front Med (Lausanne) 2019; 6:284. [PMID: 31867335 PMCID: PMC6904313 DOI: 10.3389/fmed.2019.00284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer remains a serious oncological problem worldwide. The delayed diagnosis and a prevalence of advanced stages in up to 70% of cases at recognition are still observed. Thanks to targeted therapies and immunotherapy a significant progress in achieving prolonged survival in some lung cancer patients is reported. A precise histopathological diagnosis, especially the recognition of adenocarcinoma, and a progress in the methods of clinical staging underlie the proper qualification of patients for a tailored therapy. The deep molecular characteristics of lung cancer in liquid biopsy, for example blood, bronchoalveolar lavage fluid (BALF), cell suspension from needle aspirates, are currently available. The molecular characteristic has recently been extended with molecular aberrations of BRAF, KRAS, MET, ERBB2, RET, NTRK next to the well-known EGFR mutations and ALK, ROS-1 relocation. The present paper discusses the usefulness of adequate pathological methods and molecular testing for the identification of a broad spectrum of predictive biomarkers for a molecular-directed lung cancer therapy. Immunotherapy with immune checkpoint inhibitors (ICIs) is approved in the first line therapy of advanced non-small-cell lung cancer. To date only PD-L1 expression on tumor cells has been found to be a marker of response to ICIs. The efficacy of ICIs as well as the susceptibility to immune-related adverse events are highly individual, so immune biomarkers are widely investigated. The candidates for predictive factors for ICIs immunotherapy include cancer cell antigenicity, presence of regulatory/suppressory molecules on cancer cells, cancer stem cells or on exosomes, and, on the other hand, an immune status of the patient. Cancers with high immune infiltration in the tumor milieu, referred to as “hot” tumors, seem to ensure a better response to ICIs than the “cold” ones. BALF analysis may replace cancer tissue examination, which is of limited access in advanced stages, for the recognition of the nature of immune response in the tumor environment. Tumor mutational burden (TMB) was shown to correlate with a good response to ICIs, especially when combined with other anticancer therapies. The present paper demonstrates the results of recent studies on lung cancer characteristics which bring us closer to the definition of useful prognostic/predictive factors.
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Affiliation(s)
- Joanna Domagala-Kulawik
- Department of Internal Medicine, Pulmonary Diseases and Allergy Medical University of Warsaw, Warsaw, Poland
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185
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Vincenten JPL, van Essen HF, Lissenberg-Witte BI, Bulkmans NWJ, Krijgsman O, Sie D, Eijk PP, Smit EF, Ylstra B, Thunnissen E. Clonality analysis of pulmonary tumors by genome-wide copy number profiling. PLoS One 2019; 14:e0223827. [PMID: 31618260 PMCID: PMC6795528 DOI: 10.1371/journal.pone.0223827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/30/2019] [Indexed: 01/15/2023] Open
Abstract
Multiple tumors in patients are frequently diagnosed, either synchronous or metachronous. The distinction between a second primary and a metastasis is important for treatment. Chromosomal DNA copy number aberrations (CNA) patterns are highly unique to specific tumors. The aim of this study was to assess genome-wide CNA-patterns as method to identify clonally related tumors in a prospective cohort of patients with synchronous or metachronous tumors, with at least one intrapulmonary tumor. In total, 139 tumor pairs from 90 patients were examined: 35 synchronous and 104 metachronous pairs. Results of CNA were compared to histological type, clinicopathological methods (Martini-Melamed-classification (MM) and ACCP-2013-criteria), and, if available, EGFR- and KRAS-mutation analysis. CNA-results were clonal in 74 pairs (53%), non-clonal in 33 pairs (24%), and inconclusive in 32 pairs (23%). Histological similarity was found in 130 pairs (94%). Concordance between histology and conclusive CNA-results was 69% (74 of 107 pairs: 72 clonal and two non-clonal). In 31 of 103 pairs with similar histology, genetics revealed non-clonality. In two out of four pairs with non-matching histology, genetics revealed clonality. The subgroups of synchronous and metachronous pairs showed similar outcome for the comparison of histological versus CNA-results. MM-classification and ACCP-2013-criteria, applicable on 34 pairs, and CNA-results were concordant in 50% and 62% respectively. Concordance between mutation matching and conclusive CNA-results was 89% (8 of 9 pairs: six clonal and two non-clonal). Interestingly, in one patient both tumors had the same KRAS mutation, but the CNA result was non-clonal. In conclusion, although some concordance between histological comparison and CNA profiling is present, arguments exist to prefer extensive molecular testing to determine whether a second tumor is a metastasis or a second primary.
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Affiliation(s)
- Julien P. L. Vincenten
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Albert Schweitzer Hospital, Department of Pulmonary Diseases, Dordrecht, The Netherlands
| | - Hendrik F. van Essen
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | | | | | - Oscar Krijgsman
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Molecular Oncology & Immunology, Amsterdam, The Netherlands
| | - Daoud Sie
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Paul P. Eijk
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Egbert F. Smit
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Thoracic Oncology, Amsterdam, The Netherlands
| | - Bauke Ylstra
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Erik Thunnissen
- Amsterdam UMC, location VUmc, Department of Pathology, Amsterdam, The Netherlands
- * E-mail:
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186
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Updated guidelines for predictive biomarker testing in advanced non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. Clin Transl Oncol 2019; 22:989-1003. [PMID: 31598903 PMCID: PMC7260262 DOI: 10.1007/s12094-019-02218-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
In 2011 the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) started a joint project to establish guidelines on biomarker testing in patients with advanced non-small-cell lung cancer (NSCLC) based on current evidence. As this field is constantly evolving, these guidelines have been updated, previously in 2012 and 2015 and now in 2019. Current evidence suggests that the mandatory tests to conduct in all patients with advanced NSCLC are for EGFR and BRAF mutations, ALK and ROS1 rearrangements and PD-L1 expression. The growing need to study other emerging biomarkers has promoted the routine use of massive sequencing (next-generation sequencing, NGS). The coordination of every professional involved and the prioritisation of the most suitable tests and technologies for each case remains a challenge.
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187
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Zhu X, Qiu J, Zhang T, Yang Y, Guo S, Li T, Jiang K, Zahoor A, Deng G, Qiu C. MicroRNA-188-5p promotes apoptosis and inhibits cell proliferation of breast cancer cells via the MAPK signaling pathway by targeting Rap2c. J Cell Physiol 2019; 235:2389-2402. [PMID: 31541458 DOI: 10.1002/jcp.29144] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/23/2019] [Indexed: 12/28/2022]
Abstract
Breast cancer is a common malignancy that is highly lethal with poor survival rates and immature therapeutics that urgently needs more effective and efficient therapies. MicroRNAs are intrinsically involved in different cancer remedies, but their mechanism in breast cancer has not been elucidated for prospective treatment. The function and mechanism of microRNA-188-5p (miR-188) have not been thoroughly investigated in breast cancer. In our study, we found that the expression of miR-188 in breast cancer tissues was obviously reduced. Our findings also revealed the abnormal overexpression of miR-188 in 4T1 and MCF-7 cells significantly suppressed cell proliferation and migration and also enhanced apoptosis. miR-188 induced cell cycle arrest in the G1 phase. To illuminate the molecular mechanism of miR-188, Rap2c was screened as a single target gene by bioinformatics database analysis and was further confirmed by dual-luciferase assay. Moreover, Rap2c was found to be a vital molecular switch for the mitogen-activated protein kinase signaling pathway in tumor progression by decreasing apoptosis and promoting proliferation and migration. In conclusion, our results revealed that miR-188 is a cancer progression suppressor and a promising future target for breast cancer therapy.
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Affiliation(s)
- Xinying Zhu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Jinxia Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Tao Zhang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yaping Yang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Shuai Guo
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Tianshun Li
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China.,Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Kangfeng Jiang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Arshad Zahoor
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ganzhen Deng
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Changwei Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
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188
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Zhao L, Mao C, Xiao H, Fu P, Xiao H, Chen C, Wang G. Simultaneous expression of TTF1 and GATA3 in a lung biopsy sample: confusion in diagnostic pathology. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:3613-3619. [PMID: 31934211 PMCID: PMC6949810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In daily work, pathologists often use TTF1 and GATA3 in the differential diagnosis of primary lung adenocarcinoma (TTF1+ GATA3-) and metastatic bladder cancer (or breast cancer) (TTF1- GATA3+). However, we encountered a small lung biopsy sample of TTF1+ GATA3+ (clinically suggesting both lung and bladder occupancy), and the dyeing results caused us great confusion; thus, we intended to determine the expressions of TTF1 and GATA3 in lung and bladder cancer by expanding the sample. METHODS The study included a complete case report and the tissue microarrays including pulmonary squamous cell carcinomas (n = 55), lung adenocarcinomas (n = 47), high-grade (n = 68) and low-grade (n = 43) urothelial carcinomas of the bladder. TTF1 and GATA3 immunohistochemical staining were performed on the tissue microarrays, and the relevant literature was retrieved. RESULTS Our staining results on tissue microarrays showed that TTF1 was expressed in pulmonary adenocarcinomas (44/47, 93.6%), squamous cell carcinomas (1/55, 1.8%), low-grade (1/43, 2.3%) and high-grade (2/68, 2.9%) urothelial carcinomas; GATA3 was only expressed in urothelial carcinomas of the bladder (high-grade: 48/68, 70.6%; low-grade: 42/43, 97.7%). Our literature search results showed that TTF1 could be expressed in a very small number of bladder urothelial carcinomas, and GATA3 could be expressed in a few primary lung squamous cell carcinomas and a very small number of primary lung adenocarcinomas. CONCLUSIONS TTF1 and GATA3 are good markers in the differential diagnosis of primary non-small cell lung cancer (GATA3-) and metastatic urothelial carcinoma of the bladder (GATA3+). However, pathologists should pay attention to a few special cases: lung cancer may express GATA3, and urothelial carcinoma may express TTF1. In these cases, some additional immunohistochemical markers, such as napsin A and URO III, should be added to assist the diagnosis.
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Affiliation(s)
- Lianhua Zhao
- Department of Pathology, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - Chengyi Mao
- Department of Pathology, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - He Xiao
- Cancer Center, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - Ping Fu
- Department of Pathology, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - Hualiang Xiao
- Department of Pathology, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - Chuan Chen
- Cancer Center, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
| | - Ge Wang
- Cancer Center, Daping Hospital, Army Medical UniversityNo. 10 Changjiang Zhilu, Yuzhong District, Chongqing 400042, China
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189
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Warth A, Fink L. [Immunophenotyping of lung tumors : An update]. DER PATHOLOGE 2019; 40:506-513. [PMID: 30937512 DOI: 10.1007/s00292-019-0589-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The WHO Classification of Lung Tumors (2015) established the use of immunohistochemical stainings for resection specimens, however, detailed recommendations had been missing. Now, an international expert panel has summarized key questions for daily routine practice and provided recommendations to assist the community in the appropriate use of immunohistochemistry in this context. This article provides an overview of the most important aspects.
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Affiliation(s)
- A Warth
- Institut für Pathologie, Zytopathologie und Molekularpathologie, MVZ ÜGP Gießen/Wetzlar/Limburg, Forsthausstr. 1, 35578, Wetzlar, Deutschland.
| | - L Fink
- Institut für Pathologie, Zytopathologie und Molekularpathologie, MVZ ÜGP Gießen/Wetzlar/Limburg, Forsthausstr. 1, 35578, Wetzlar, Deutschland
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190
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Ho HL, Kao HL, Yeh YC, Chou TY. The importance of EGFR mutation testing in squamous cell carcinoma or non-small cell carcinoma favor squamous cell carcinoma diagnosed from small lung biopsies. Diagn Pathol 2019; 14:59. [PMID: 31221183 PMCID: PMC6587243 DOI: 10.1186/s13000-019-0840-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2019] [Indexed: 01/15/2023] Open
Abstract
Background Adenosquamous carcinoma (ADSC) of the lung, a rare but aggressive subtype of non-small cell lung cancer (NSCLC), is defined as a carcinoma containing components of adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). Mutations of epidermal growth factor receptor (EGFR) are found at a frequency of 15 to 44% in Asian ADSC, and EGFR tyrosine kinase inhibitors (EGFR-TKIs) are a more effective treatment for EGFR-mutated ADSC compared to chemotherapy. However, ADSC in small lung biopsies could be misdiagnosed as SqCC or non-small cell carcinoma (NSCC) favor SqCC due to undersampling, which may result in neglecting of EGFR mutation testing and affecting patients’ clinical management, particularly in Asian patients that relatively have high prevalence of EGFR mutation. Methods A total of 148 small lung biopsy cases with pathological diagnosis of SqCC or NSCC favor SqCC were retrospectively enrolled. The frequency of EGFR mutations and the correlation between patients’ EGFR mutation status and clinicopathological characteristics were evaluated. Results EGFR mutations were found in 8.8% (13 /148) of all cases with 5.2% (7/135) in SqCC and 46.2% (6/13) in NSCC favor SqCC. There were 7 (53.8%) L858R mutation, 4 (30.8%) exon 19 deletions, and 2 (15.4%) cases with coexistent L858R and T790 M mutations. Multivariate analysis showed that EGFR mutations were more prevalent in never-smokers (83.3% versus 16.7%, p = 0.006) and patients diagnosed as NSCC favor SqCC (46.2% versus 5.2%, p = 0.001). Moreover, 75% (3/4) of EGFR mutation-positive cases with subsequent surgical resection or rebiopsy were further diagnosed as ADSC. Conclusions EGFR mutation testing should be performed in Asian patients with SqCC diagnosed from small lung biopsies, especially in never-smokers and patients with diagnosis of NSCC favor SqCC, which have a high probability of being ADSC.
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Affiliation(s)
- Hsiang-Ling Ho
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hua-Lin Kao
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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191
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Jain D, Nambirajan A, Borczuk A, Chen G, Minami Y, Moreira AL, Motoi N, Papotti M, Rekhtman N, Russell PA, Savic Prince S, Yatabe Y, Bubendorf L. Immunocytochemistry for predictive biomarker testing in lung cancer cytology. Cancer Cytopathol 2019; 127:325-339. [PMID: 31050216 DOI: 10.1002/cncy.22137] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/28/2022]
Abstract
With an escalating number of predictive biomarkers emerging in non-small cell lung carcinoma (NSCLC), immunohistochemistry (IHC) is being used as a rapid and cost-effective tool for the screening and detection of many of these markers. In particular, robust IHC assays performed on formalin-fixed, paraffin-embedded (FFPE) tumor tissue are widely used as surrogate markers for ALK and ROS1 rearrangements and for detecting programmed death ligand 1 (PD-L1) expression in patients with advanced NSCLC; in addition, they have become essential for treatment decisions. Cytology samples represent the only source of tumor in a significant proportion of patients with inoperable NSCLC, and there is increasing demand for predictive biomarker testing on them. However, the wide variation in the types of cytology samples and their preparatory methods, the use of alcohol-based fixatives that interfere with immunochemistry results, the difficulty in procurement of cytology-specific controls, and the uncertainty regarding test validity have resulted in underutilization of cytology material for predictive immunocytochemistry (ICC), and most cytopathologists limit such testing to FFPE cell blocks (CBs). The purpose of this review is to: 1) analyze various preanalytical, analytical, and postanalytical factors influencing ICC results; 2) discuss measures for validation of ICC protocols; and 3) summarize published data on predictive ICC for ALK, ROS1, EGFR gene alterations and PD-L1 expression on lung cancer cytology. Based on our experience and from a review of the literature, we conclude that cytology specimens are in principal suitable for predictive ICC, but proper optimization and rigorous quality control for high-quality staining are essential, particularly for non-CB preparations.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alain Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuko Minami
- Department of Pathology, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prudence A Russell
- Anatomical Pathology Department, St. Vincent's Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | | | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
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192
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VanderLaan PA. Non–small cell lung cancer predictive biomarker testing via immunocytochemistry: Ways of future past? Cancer Cytopathol 2019; 127:278-280. [DOI: 10.1002/cncy.22138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Paul A. VanderLaan
- Department of Pathology Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts
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193
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Zhou F, Moreira AL. The Role of Ancillary Techniques in Pulmonary Cytopathology. Acta Cytol 2019; 64:166-174. [PMID: 31013490 DOI: 10.1159/000498889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
Ancillary techniques play an essential role in pulmonary cytopathology. Immunoperoxidase and special stains are by far the most common ancillary techniques used in cytopathology; however, the role of molecular diagnosis is growing, especially in the fields of pulmonary oncology and infectious disease. In this article, we review the uses of ancillary techniques in lung tumor diagnosis, lung tumor classification, predictive marker determination, primary versus metastasis differential diagnosis, and infectious organism detection.
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Affiliation(s)
- Fang Zhou
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Andre L Moreira
- Department of Pathology, New York University School of Medicine, New York, New York, USA,
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