Prognostic value of complex glandular patterns in invasive pulmonary adenocarcinomas

Bossé, Yohan; Gagné, Andréanne; Althakfi, Wajd Ahmed; Orain, Michèle; Fiset, Pierre; Desmeules, Patrice; Joubert, Philippe

doi:10.1016/j.humpath.2022.07.007

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…2h) are considered high-grade patterns and have significant impacts on clinical outcomes in patients with lung adenocarcinomas. 8,10,11…”

Section: New High-grade Patterns Of Lung Adenocarcinomamentioning

confidence: 99%

“…2h) as a predominant pattern has been shown to be associated with poor prognosis akin to solid and micropapillary patterns, whereas the 5-year survival for patients with fused gland-predominant adenocarcinomas ranked between papillary-and micropapillary-predominant tumors. 11 Histologically, cribriform-predominant adenocarcinoma is associated with larger tumor size, more frequent pleural involvement, lymphovascular invasion, and spread through airspaces (STAS), and recurrent tumors with cribriform pattern may have therapeutic implications with tyrosine kinase inhibitors in a small subset of patients. 15 These data suggest that the cribriform pattern could be recognized as a stand-alone aggressive subtype, and such classification would further stratify the prognostic values of the complex glandular pattern and potentially provide guidance for targeted therapy.…”

Section: Complex Glandular Pattern (Cgp)mentioning

confidence: 99%

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An Update on the Classification of Lung and Pleural Tumors

Liang¹,

Xu²

2023

J Clin Transl Pathol

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The World Health Organization (WHO) recently published new guidelines for the diagnosis and classification of lung and pleural tumors. This review provides a concise overview of the key updates, including discussions of histologic features and recommended terminology for small diagnostic lung samples, the revised grading system for lung adenocarcinoma with inclusion of complex glandular and filigree micropapillary patterns, and molecular features of large cell neuroendocrine carcinoma. Additionally, rare neoplasms such as bronchiolar adenoma/ciliated muconodular papillary tumor, SMARCA4-deficient undifferentiated thoracic tumor, and primary pulmonary hyalinizing clear cell carcinoma are described in terms of their diagnostic approaches and molecular features. This review also includes discussion of the diagnostic algorithm for malignant epithelioid mesothelioma.

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“…2h) are considered high-grade patterns and have significant impacts on clinical outcomes in patients with lung adenocarcinomas. 8,10,11…”

Section: New High-grade Patterns Of Lung Adenocarcinomamentioning

confidence: 99%

Section: Complex Glandular Pattern (Cgp)mentioning

confidence: 99%

An Update on the Classification of Lung and Pleural Tumors

Liang¹,

Xu²

2023

J Clin Transl Pathol

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“…[25][26][27] Under the IASLC/WHO grading system, the prevalence of grade 2 tumors is decreased, with a higher proportion of grade 3 lesions. For instance, in some studies up to 70% of adenocarcinomas are considered to be grade 3, 24,25,28 while in others grade 2 tumors remain the most common, although at a lower proportion of the total. [29][30][31][32] This can be attributed to the fact that the IASCL/WHO system accounts for the presence of secondary high-grade patterns, as well as the consideration of complex glandular pattern as such.…”

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confidence: 99%

“…These tumors are the least commonly observed lung adenocarcinoma in most series. 21,24,25,27,28,31,32 An example of lepidic pattern is shown in Figure 1A. In the current staging system, the lepidic component of adenocarcinoma is considered as an in situ adenocarcinoma and should be subtracted from the total tumor size.…”

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confidence: 99%

The Grading System for Lung Adenocarcinoma: Brief Review of its Prognostic Performance and Future Directions

Mantilla,

Moreira

2024

Advances in Anatomic Pathology

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Histologic grading of tumors is associated with prognosis in many organs. In the lung, the most recent grading system proposed by International association for the Study of Lung Cancer (IASLC) and adopted by the World Health Organization (WHO) incorporates the predominant histologic pattern, as well as the presence of high-grade architectural patterns (solid, micropapillary, and complex glandular pattern) in proportions >20% of the tumor surface. This system has shown improved prognostic ability when compared with the prior grading system based on the predominant pattern alone, across different patient populations. Interobserver agreement is moderate to excellent, depending on the study. IASLC/WHO grading system has been shown to correlate with molecular alterations and PD-L1 expression in tumor cells. Recent studies interrogating gene expression has shown correlation with tumor grade and molecular alterations in the tumor microenvironment that can further stratify risk of recurrence. The use of machine learning algorithms to grade nonmucinous adenocarcinoma under this system has shown accuracy comparable to that of expert pulmonary pathologists. Future directions include evaluation of tumor grade in the context of adjuvant and neoadjuvant therapies, as well as the development of better prognostic indicators for mucinous adenocarcinoma.

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“…In addition, other predictors of prognosis have been identified based on morphologic and cytologic criteria. This includes nontraditional patterns such as cribriform and fused glands 5–12…”

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confidence: 99%

A Simplified Version of the IASLC Grading System for Invasive Pulmonary Adenocarcinomas With Improved Prognosis Discrimination

Bossé

Gagné

Althakfi

et al. 2023

American Journal of Surgical Pathology

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Tumor grading enables better management of patients and treatment options. The International Association for the Study of Lung Cancer (IASLC) Pathology Committee has recently released a 3-tier grading system for invasive pulmonary adenocarcinoma consisting of predominant histologic patterns plus a cutoff of 20% of high-grade components including solid, micropapillary, and complex glandular patterns. The goal of this study was to validate the prognostic value of the new IASLC grading system and to compare its discriminatory performance to the predominant pattern-based grading system and a simplified version of the IASLC grading system without complex glandular patterns. This was a single-site retrospective study based on a 20-year data collection of patients that underwent lung cancer surgery. All invasive pulmonary adenocarcinomas confirmed by the histologic review were evaluated in a discovery cohort (n = 676) and a validation cohort (n = 717). The median duration of follow-up in the combined dataset (n = 1393) was 7.5 years. The primary outcome was overall survival after surgery. The 3 grading systems had strong and relatively similar predictive performance, but the best parsimonious model was the simplified IASLC grading system (log-rank P = 1.39E−13). The latter was strongly associated with survival in the validation set (P = 1.1E−18) and the combined set (P = 5.01E−35). We observed a large proportion of patients upgraded to the poor prognosis group using the IASLC grading system, which was attenuated when using the simplified IASLC grading system. In conclusion, we identified a histologic simpler classification for invasive pulmonary adenocarcinomas that outperformed the recently proposed IASLC grading system. A simplified grading system is clinically convenient and will facilitate widespread implementation.

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Prognostic value of complex glandular patterns in invasive pulmonary adenocarcinomas

Cited by 8 publications

References 11 publications

An Update on the Classification of Lung and Pleural Tumors

An Update on the Classification of Lung and Pleural Tumors

The Grading System for Lung Adenocarcinoma: Brief Review of its Prognostic Performance and Future Directions

A Simplified Version of the IASLC Grading System for Invasive Pulmonary Adenocarcinomas With Improved Prognosis Discrimination

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