1
|
Sasaki T, Kuno H, Hiyama T, Oda S, Masuoka S, Miyasaka Y, Taki T, Nagasaki Y, Ohtani-Kim SJY, Ishii G, Kaku S, Shroff GS, Kobayashi T. 2021 WHO Classification of Lung Cancer: Molecular Biology Research and Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230136. [PMID: 38358935 DOI: 10.1148/rg.230136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The 2021 World Health Organization (WHO) classification system for thoracic tumors (including lung cancer) contains several updates to the 2015 edition. Revisions for lung cancer include a new grading system for invasive nonmucinous adenocarcinoma that better reflects prognosis, reorganization of squamous cell carcinomas and neuroendocrine neoplasms, and description of some new entities. Moreover, remarkable advancements in our knowledge of genetic mutations and targeted therapies have led to a much greater emphasis on genetic testing than that in 2015. In 2015, guidelines recommended evaluation of only two driver mutations, ie, epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) fusions, in patients with nonsquamous non-small cell lung cancer. The 2021 guidelines recommend testing for numerous additional gene mutations for which targeted therapies are now available including ROS1, RET, NTRK1-3, KRAS, BRAF, and MET. The correlation of imaging features and genetic mutations is being studied. Testing for the immune biomarker programmed death ligand 1 is now recommended before starting first-line therapy in patients with metastatic non-small cell lung cancer. Because 70% of lung cancers are unresectable at patient presentation, diagnosis of lung cancer is usually based on small diagnostic samples (ie, biopsy specimens) rather than surgical resection specimens. The 2021 version emphasizes differences in the histopathologic interpretation of small diagnostic samples and resection specimens. Radiologists play a key role not only in evaluation of tumor and metastatic disease but also in identification of optimal biopsy targets. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
Collapse
Affiliation(s)
- Tomoaki Sasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Hirofumi Kuno
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Takashi Hiyama
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Shioto Oda
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sota Masuoka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Miyasaka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tetsuro Taki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Nagasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Seiyu Jeong-Yoo Ohtani-Kim
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Genichiro Ishii
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sawako Kaku
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tatsushi Kobayashi
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| |
Collapse
|