EURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach.
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Nicholson Andrew G, Sauter Jennifer L, Nowak Anna K, Kindler Hedy L, Gill Ritu R, Remy-Jardin Martine, Armato Samuel G, Fernandez-Cuesta Lynnette, Bueno Raphael, Alcala Nicolas, Foll Matthieu, Pass Harvey, Attanoos Richard, Baas Paul, Beasley Mary Beth, Brcic Luka, Butnor Kelly J, Chirieac Lucian R, Churg Andrew, Courtiol Pierre, Dacic Sanja, De Perrot Marc, Frauenfelder Thomas, Gibbs Allen, Hirsch Fred R, Hiroshima Kenzo, Husain Aliya, Klebe Sonja, Lantuejoul Sylvie, Moreira Andre, Opitz Isabelle, Perol Maurice, Roden Anja, Roggli Victor, Scherpereel Arnaud, Tirode Frank, Tazelaar Henry, Travis William D, Tsao Ming-Sound, van Schil Paul, Vignaud Jean Michel, Weynand Birgit, Lang-Lazdunski Loic, Cree Ian, Rusch Valerie W, Girard Nicolas, Galateau-Salle Francoise
Аннотация
METHODS: A multidisciplinary group (pathologists, molecular biologists, surgeons, radiologists, and oncologists), sponsored by European Network for Rare Adult Solid Cancers/International Association for the Study of Lung Cancer, met in 2018 to critically review the current classification.
RESULTS: Recommendations include: (1) classification should be updated to include architectural patterns and stromal and cytologic features that refine prognostication; (2) subject to data accrual, malignant mesothelioma in situ could be an additional category; (3) grading of epithelioid malignant pleural mesotheliomas should be routinely undertaken; (4) favorable/unfavorable histologic characteristics should be routinely reported; (5) clinically relevant molecular data (programmed death ligand 1, BRCA 1 associated protein 1 [BAP1], and cyclin dependent kinase inhibitor 2A) should be incorporated into reports, if undertaken; (6) other molecular data should be accrued as part of future trials; (7) resection specimens (i.e., extended pleurectomy/decortication and extrapleural pneumonectomy) should be pathologically staged with smaller specimens being clinically staged; (8) ideally, at least three separate areas should be sampled from the pleural cavity, including areas of interest identified on pre-surgical imaging; (9) image-acquisition protocols/imaging terminology should be standardized to aid research/refine clinical staging; (10) multidisciplinary tumor boards should include pathologists to ensure appropriate treatment options are considered; (11) all histologic subtypes should be considered potential candidates for chemotherapy; (12) patients with sarcomatoid or biphasic mesothelioma should not be excluded from first-line clinical trials unless there is a compelling reason; (13) tumor subtyping should be further assessed in relation to duration of response to immunotherapy; and (14) systematic screening of all patients for germline mutations is not recommended, in the absence of a family history suspicious for BAP1 syndrome.
CONCLUSIONS: These multidisciplinary recommendations for pathology classification and application will allow more informative pathologic reporting and potential risk stratification, to support clinical practice, research investigation and clinical trials.