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Subsolid pulmonary nodules: CT–pathologic correlation using the 2011 IASLC/ATS/ERS classification

Published:December 20, 2014DOI:https://doi.org/10.1016/j.clinimag.2014.12.009

      Abstract

      Adenocarcinoma is the most common histologic subtype of lung cancer. Recent advances in oncology, molecular biology, pathology, imaging, and treatment have led to an increased understanding of this disease. In 2011, the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society published a new international multidisciplinary classification. Using this taxonomy, we review the spectrum of subsolid pulmonary nodules seen on computed tomography together with their histopathologic correlates and current management guidelines.

      Keywords

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      References

        • American Cancer Society
        Cancer facts & figure 2013.
        American Cancer Society, Atlanta, GA2013 ([Accessed at www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures 2013 on 12 January 2014])
        • Travis WD
        • Travis LB
        • Devesa SS
        Lung cancer.
        Cancer. 1995; 75: 191-202
        • Humphrey L
        • Deffebach M
        • Pappas M
        • Baumann C
        • Artis K
        • Mitchell JP
        • et al.
        Screening for lung cancer: systematic review to update the U.S. Preventive Services Task Force recommendation statement.
        Evidence synthesis no. 105. AHRQ publication no. 13-05196-EF-1. Agency for Healthcare Research and Quality, Rockville, MD2013
        • Yoshizawa A
        • Motoi N
        • Riely GJ
        • Sima CS
        • Gerald WL
        • Kris MG
        • et al.
        Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases.
        Mod Pathol. 2011; 24: 653-664
        • Aoki T
        • Tomoda Y
        • Watanabe H
        • Nakata H
        • Kasai T
        • Hashimoto H
        • et al.
        Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival.
        Radiology. 2001; 220: 803-809
        • Moyer V
        Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2014; 160: 330-338
        • Henschke CI
        • Yankelevitz DF
        • Mirtcheva R
        • McGuinness G
        • McCauley D
        • Miettinen OS
        ELCAP Group: CT screening for lung cancer—frequency and significance of part-solid and nonsolid nodules.
        AJR Am J Roentgenol. 2002; 178: 1053-1057
        • Noguchi M
        • Morikawa A
        • Kawasaki M
        • Matsuno Y
        • Yamada T
        • Hirohashi S
        • et al.
        Small adenocarcinoma of the lung. Histologic characteristics and prognosis.
        Cancer. 1995; 75: 2844-2852
        • Kaneko M
        • Eguchi K
        • Ohmatsu H
        • Kakinuma R
        • Naruke T
        • Suemasu K
        • et al.
        Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography.
        Radiology. 1996; 201: 798-802
        • Ebright MI
        • Zakowski MF
        • Martin J
        • Venkatraman ES
        • Miller VA
        • Bains MS
        • et al.
        Clinical pattern and pathologic stage but not histologic features predict outcome for bronchioloalveolar carcinoma.
        Ann Thorac Surg. 2002; 74 ([discussion 1646–7]): 1640-1646
        • Travis WD
        • Colby TV
        • Corrin B
        • Shimosato Y
        • Brambilla E
        • in collaboration with Sobin LH and pathologists from 14 countries
        World Health Organization international histological classification of tumours.
        3rd ed. Histological typing of lung and pleural tumours. Springer-Verlag, 1999
        • Travis WD
        • Garg K
        • Franklin WA
        • Wistuba II
        • Sabloff B
        • Noguchi M
        • et al.
        Bronchioloalveolar carcinoma and lung adenocarcinoma: the clinical importance and research relevance of the 2004 World Health Organization pathologic criteria.
        J Thorac Oncol. 2006; 1: S13-S19
        • Travis WD
        • Brambilla E
        • Noguchi M
        • Nicholson AG
        • Geisinger KR
        • Yatabe Y
        • et al.
        International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma.
        J Thorac Oncol. 2011; 6: 244-285
        • Lee SM
        • Goo JM
        • Park CM
        • Lee HJ
        • Im JG
        A new classification of adenocarcinoma: what the radiologists need to know.
        Diagn Interv Radiol. 2012; 18: 519-526
        • Weng S
        • Tsuchiya E
        • Satoh Y
        • Kitagawa T
        • Nakagawa K
        • Sugano H
        Multiple atypical hyperplasia of type II pneumocytes and bronchioloalveolar carcinoma.
        Histopathology. 1990; 16: 101-103
        • Mori M
        • Rao SK
        • Popper HH
        • Cagle PT
        • Fraire AE
        Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung.
        Mod Pathol. 2001; 14: 72-84
        • Yokose T
        • Doi M
        • Tanno K
        • Yamazaki K
        • Ochiai A
        Atypical adenomatous hyperplasia of the lung in autopsy cases.
        Lung Cancer. 2001; 33: 155-161
        • Chapman AD
        • Kerr KM
        The association between atypical adenomatous hyperplasia and primary lung cancer.
        Br J Cancer. 2000; 83: 632-636
        • Park CM
        • Goo JM
        • Lee HJ
        • Lee CH
        • Kim HC
        • Chung DH
        • et al.
        CT findings of atypical adenomatous hyperplasia in the lung.
        Korean J Radiol. 2006; 7: 80-86
        • Kayser K
        • Nwoye JO
        • Kosjerina Z
        • Goldmann T
        • Vollmer E
        • Kaltner H
        • et al.
        Atypical adenomatous hyperplasia of lung: its incidence and analysis of clinical, glycohistochemical and structural features including newly defined growth regulators and vascularization.
        Lung Cancer. 2003; 42: 171-182
        • Park BM
        • Cho MJ
        • Lee HS
        • Park DI
        • Park MR
        • Kim JO
        • et al.
        A case of atypical adenomatous hyperplasia of larger than 2 cm.
        Tuberc Respir Dis. 2013; 74: 280-285
        • Borczuk AC
        Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma.
        Mod Pathol. 2012; 25: S1-S10
        • Jones KD
        Whence lepidic? The history of a Canadian neologism.
        Arch Pathol Lab Med. 2013; 137: 1822-1824
        • Watanabe S
        • Watanabe T
        • Arai K
        • Kasai T
        • Haratake J
        • Urayama H
        Results of wedge resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography.
        Ann Thorac Surg. 2002; 73: 1071-1075
        • Sakurai H
        • Dobashi Y
        • Mizutani E
        • Matsubara H
        • Suzuki S
        • Takano K
        • et al.
        Bronchioloalveolar carcinoma of the lung 3 centimeters or less in diameter: a prognostic assessment.
        Ann Thorac Surg. 2004; 78: 1728-1733
        • Yim J
        • Zhu LC
        • Chiriboga L
        • Watson HN
        • Goldberg JD
        • Moreira AL
        Histologic features are important prognostic indicators in early stages lung adenocarcinomas.
        Mod Pathol. 2007; 20: 233-241
        • Maeshima AM
        • Tochigi N
        • Yoshida A
        • Asamura H
        • Tsuta K
        • Tsuda H
        Histological scoring for small lung adenocarcinomas 2 cm or less in diameter: a reliable prognostic indicator.
        J Thorac Oncol. 2010; 5: 333-339
        • Kadota K
        • Yeh YC
        • D'Angelo SP
        • Moreira AL
        • Kuk D
        • Sima CS
        • et al.
        Associations between mutations and histologic patterns of mucin in lung adenocarcinoma: invasive mucinous pattern and extracellular mucin are associated with KRAS mutation.
        Am J Surg Pathol. 2014; 38: 1118-1127
        • Sugano M
        • Nagasaka T
        • Sasaki E
        • Murakami Y
        • Hosoda W
        • Hida T
        • et al.
        HNF4α as a marker for invasive mucinous adenocarcinoma of the lung.
        Am J Surg Pathol. 2013; 37: 211-218
        • Sakao Y
        • Sakuragi T
        • Natsuaki M
        • Itoh T
        Clinicopathological analysis of prognostic factors in clinical IA peripheral adenocarcinoma of the lung.
        Ann Thorac Surg. 2003; 75: 1113-1117
        • Sakao Y
        • Miyamoto H
        • Sakuraba M
        • Oh T
        • Shiomi K
        • Sonobe S
        • et al.
        Prognostic significance of a histologic subtype in small adenocarcinoma of the lung: the impact of nonbronchioloalveolar carcinoma components.
        Ann Thorac Surg. 2007; 83: 214-215
        • Lim HJ
        • Ahn S
        • Lee KS
        • Han J
        • Shim YM
        • Woo S
        • et al.
        Persistent pure ground-glass opacity lung nodules ≥ 10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications.
        Chest. 2013; 144: 1291-1299
        • Vazquez M
        • Carter D
        • Brambilla E
        • Gazdar A
        • Noguchi M
        • Travis WD
        • et al.
        Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications.
        Lung Cancer. 2009; 64: 148-154
        • Nakata M
        • Sawada S
        • Yamashita M
        • Saeki H
        • Kurita A
        • Takashima S
        • et al.
        Surgical treatments for multiple primary adenocarcinoma of the lung.
        Ann Thorac Surg. 2004; 78: 1194-1199
        • Zwirewich CV
        • Miller RR
        • Muller NL
        Multicentric adenocarcinoma of the lung: CT–pathologic correlation.
        Radiology. 1990; 176: 185-190
        • Girard N
        • Deshpande C
        • Lau C
        • Finley D
        • Rusch V
        • Pao W
        • et al.
        Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases.
        Am J Surg Pathol. 2009; 33: 1752-1764
        • Barsky SH
        • Grossman DA
        • Ho J
        • Holmes EC
        The multifocality of bronchioloalveolar lung carcinoma: evidence and implications of a multiclonal origin.
        Mod Pathol. 1994; 7: 633-640
        • Kim HK
        • Choi YS
        • Kim J
        • Shim YM
        • Lee KS
        • Kim K
        Management of multiple pure ground-glass opacity lesions in patients with bronchioloalveolar carcinoma.
        J Thorac Oncol. 2010; 5: 206-210
        • Larke FJ
        • Kruger RL
        • Cagnon CH
        • Flynn MJ
        • McNitt-Gray MM
        • Wu X
        • et al.
        Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial.
        AJR Am J Roentgenol. 2011; 197: 1165-1169
        • Naidich DP
        • Bankier AA
        • MacMahon H
        • Schaefer-Prokop CM
        • Pistolesi M
        • Goo JM
        • et al.
        Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society.
        Radiology. 2013; 266: 304-317
        • Solis LM
        • Behrens C
        • Raso MG
        • Lin HY
        • Kadara H
        • Yuan P
        • et al.
        Histologic patterns and molecular characteristics of lung adenocarcinoma associated with clinical outcome.
        Cancer. 2012; 118: 2889-2899
        • Sequist LV
        • Yang JC
        • Yamamoto N
        • O’Byrne K
        • Hirsch V
        • Mok T
        • et al.
        Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations.
        J Clin Oncol. 2013; 31: 3327-3334
        • Imielinski M
        • Berger AH
        • Hammerman PS
        • Hernandez B
        • Pugh TJ
        • Hodis E
        • et al.
        Mapping the hallmarks of lung adenocarcinoma with massively parallel sequencing.
        Cell. 2012; 150: 1107-1120