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Tumor islands and spread through air spaces: Distinct patterns of invasion in lung adenocarcinoma
Author(s) -
MoralesOyarvide Vicente,
MinoKenudson Mari
Publication year - 2016
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12368
Subject(s) - adenocarcinoma , lymphovascular invasion , lung , medicine , pathology , stage (stratigraphy) , lung cancer , oncology , cancer , metastasis , biology , paleontology
Lung adenocarcinoma is a highly heterogeneous disease and the heterogeneity is associated with various patient outcomes even in early‐stage tumors. In order to improve prognostic and predictive values, the IASLC / ATS / ERS international multidisciplinary lung adenocarcinoma classification was put forth in 2011 and it has been adopted in the recently published World Health Organization ( WHO ) classification of T umours of the L ung, P leura, T hymus and H eart 4th edition 2015, and lung adenocarcinomas are classified based on the predominant pattern. The performance of the classification in stratifying patient outcomes after resection of Stage I tumors and predicting molecular alterations has been confirmed by several studies. It also includes the category of minimally invasive adenocarcinoma ( MIA ) that predicts 100% 5‐year recurrence free survival after curative resection similar to adenocarcinoma in situ . The diagnosis of MIA is based on not only size of the invasive component but also the absence of aggressive morphologic features such as pleural and/or lymphovascular invasion. Importantly, the WHO 2015 classification has introduced the concept of air space invasion and includes it as the exclusion criteria for MIA . The air space invasion consists of tumor islands and spread through air spaces ( STAS ). In this review, we will discuss the two entities and their clinical implications.