What clinicians are asking pathologists when dealing with lung neuroendocrine neoplasms?

Giuseppe Pelosi, Alessandra Fabbri, Mara Cossa, Angelica Sonzogni, Barbara Valeri, Luisella Righi, Mauro Papotti

Research output: Contribution to journalArticle

Abstract

Lung neuroendocrine tumors (NET) are currently classified in resection specimens according to four histological categories, namely typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCC). Diagnostic criteria have remained unchanged in the 2015 WHO classification, which has ratified the wide acceptance and popularity of such terminology in the pathologists[U+05F3] and clinicians community. A unifying umbrella of NE morphology and differentiation has been recognized in lung NET, which has pushed to enter an unique box of invasive tumors along with diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) as a pre-invasive lesion with a potential toward the development of carcinoids. However, uncertainties remain in the terminology of lung NET upon small samples, where Ki-67 antigen could play some role to avoid misdiagnosing carcinoids as high-grade NE tumors. Epidemiologic, clinical and genetic traits support a biological three-tier over a pathology four-tier model, according to which TC are low malignancy tumors, AC intermediate malignancy tumors and LCNEC/SCC high malignancy tumors with no significant differences in survival among them. Inconsistencies in diagnostic reproducibility, troubles in the therapy of AC and LCNEC, and limitations to histology within the same tumor category argue in favor of a global re-thinking of lung NET where a grading system could play a role. This review outlines three main key questions in the field of lung NET: (A) unbiased diagnoses, (B) the role of Ki-67 and tumor grading, and (C) management of predictive markers. Answers are still inconclusive, thus additional research is required to improve our understanding on lung NET.

Original languageEnglish
Pages (from-to)469-479
Number of pages11
JournalSeminars in Diagnostic Pathology
Volume32
Issue number6
DOIs
Publication statusPublished - Nov 1 2015

Fingerprint

Carcinoid Tumor
Neuroendocrine Tumors
Lung Neoplasms
Lung
Neuroendocrine Carcinoma
Large Cell Carcinoma
Neoplasms
Small Cell Carcinoma
Neoplasm Grading
Terminology
Ki-67 Antigen
Pathologists
Diagnostic Errors
Uncertainty
Hyperplasia
Histology
Pathology
Research

Keywords

  • Carcinoid
  • Diagnosis
  • Grading
  • Immunohistochemistry
  • Ki-67
  • Large cell
  • Molecular pathology
  • Neuroendocrine
  • Predictive
  • Prognosis
  • Small cell
  • Survival
  • Tumor

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

What clinicians are asking pathologists when dealing with lung neuroendocrine neoplasms? / Pelosi, Giuseppe; Fabbri, Alessandra; Cossa, Mara; Sonzogni, Angelica; Valeri, Barbara; Righi, Luisella; Papotti, Mauro.

In: Seminars in Diagnostic Pathology, Vol. 32, No. 6, 01.11.2015, p. 469-479.

Research output: Contribution to journalArticle

@article{02fd670847fa44b19656f60e560e53ad,
title = "What clinicians are asking pathologists when dealing with lung neuroendocrine neoplasms?",
abstract = "Lung neuroendocrine tumors (NET) are currently classified in resection specimens according to four histological categories, namely typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCC). Diagnostic criteria have remained unchanged in the 2015 WHO classification, which has ratified the wide acceptance and popularity of such terminology in the pathologists[U+05F3] and clinicians community. A unifying umbrella of NE morphology and differentiation has been recognized in lung NET, which has pushed to enter an unique box of invasive tumors along with diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) as a pre-invasive lesion with a potential toward the development of carcinoids. However, uncertainties remain in the terminology of lung NET upon small samples, where Ki-67 antigen could play some role to avoid misdiagnosing carcinoids as high-grade NE tumors. Epidemiologic, clinical and genetic traits support a biological three-tier over a pathology four-tier model, according to which TC are low malignancy tumors, AC intermediate malignancy tumors and LCNEC/SCC high malignancy tumors with no significant differences in survival among them. Inconsistencies in diagnostic reproducibility, troubles in the therapy of AC and LCNEC, and limitations to histology within the same tumor category argue in favor of a global re-thinking of lung NET where a grading system could play a role. This review outlines three main key questions in the field of lung NET: (A) unbiased diagnoses, (B) the role of Ki-67 and tumor grading, and (C) management of predictive markers. Answers are still inconclusive, thus additional research is required to improve our understanding on lung NET.",
keywords = "Carcinoid, Diagnosis, Grading, Immunohistochemistry, Ki-67, Large cell, Molecular pathology, Neuroendocrine, Predictive, Prognosis, Small cell, Survival, Tumor",
author = "Giuseppe Pelosi and Alessandra Fabbri and Mara Cossa and Angelica Sonzogni and Barbara Valeri and Luisella Righi and Mauro Papotti",
year = "2015",
month = "11",
day = "1",
doi = "10.1053/j.semdp.2015.10.009",
language = "English",
volume = "32",
pages = "469--479",
journal = "Seminars in Diagnostic Pathology",
issn = "0740-2570",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - What clinicians are asking pathologists when dealing with lung neuroendocrine neoplasms?

AU - Pelosi, Giuseppe

AU - Fabbri, Alessandra

AU - Cossa, Mara

AU - Sonzogni, Angelica

AU - Valeri, Barbara

AU - Righi, Luisella

AU - Papotti, Mauro

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Lung neuroendocrine tumors (NET) are currently classified in resection specimens according to four histological categories, namely typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCC). Diagnostic criteria have remained unchanged in the 2015 WHO classification, which has ratified the wide acceptance and popularity of such terminology in the pathologists[U+05F3] and clinicians community. A unifying umbrella of NE morphology and differentiation has been recognized in lung NET, which has pushed to enter an unique box of invasive tumors along with diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) as a pre-invasive lesion with a potential toward the development of carcinoids. However, uncertainties remain in the terminology of lung NET upon small samples, where Ki-67 antigen could play some role to avoid misdiagnosing carcinoids as high-grade NE tumors. Epidemiologic, clinical and genetic traits support a biological three-tier over a pathology four-tier model, according to which TC are low malignancy tumors, AC intermediate malignancy tumors and LCNEC/SCC high malignancy tumors with no significant differences in survival among them. Inconsistencies in diagnostic reproducibility, troubles in the therapy of AC and LCNEC, and limitations to histology within the same tumor category argue in favor of a global re-thinking of lung NET where a grading system could play a role. This review outlines three main key questions in the field of lung NET: (A) unbiased diagnoses, (B) the role of Ki-67 and tumor grading, and (C) management of predictive markers. Answers are still inconclusive, thus additional research is required to improve our understanding on lung NET.

AB - Lung neuroendocrine tumors (NET) are currently classified in resection specimens according to four histological categories, namely typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCC). Diagnostic criteria have remained unchanged in the 2015 WHO classification, which has ratified the wide acceptance and popularity of such terminology in the pathologists[U+05F3] and clinicians community. A unifying umbrella of NE morphology and differentiation has been recognized in lung NET, which has pushed to enter an unique box of invasive tumors along with diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) as a pre-invasive lesion with a potential toward the development of carcinoids. However, uncertainties remain in the terminology of lung NET upon small samples, where Ki-67 antigen could play some role to avoid misdiagnosing carcinoids as high-grade NE tumors. Epidemiologic, clinical and genetic traits support a biological three-tier over a pathology four-tier model, according to which TC are low malignancy tumors, AC intermediate malignancy tumors and LCNEC/SCC high malignancy tumors with no significant differences in survival among them. Inconsistencies in diagnostic reproducibility, troubles in the therapy of AC and LCNEC, and limitations to histology within the same tumor category argue in favor of a global re-thinking of lung NET where a grading system could play a role. This review outlines three main key questions in the field of lung NET: (A) unbiased diagnoses, (B) the role of Ki-67 and tumor grading, and (C) management of predictive markers. Answers are still inconclusive, thus additional research is required to improve our understanding on lung NET.

KW - Carcinoid

KW - Diagnosis

KW - Grading

KW - Immunohistochemistry

KW - Ki-67

KW - Large cell

KW - Molecular pathology

KW - Neuroendocrine

KW - Predictive

KW - Prognosis

KW - Small cell

KW - Survival

KW - Tumor

UR - http://www.scopus.com/inward/record.url?scp=84951860738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951860738&partnerID=8YFLogxK

U2 - 10.1053/j.semdp.2015.10.009

DO - 10.1053/j.semdp.2015.10.009

M3 - Article

C2 - 26561395

AN - SCOPUS:84951860738

VL - 32

SP - 469

EP - 479

JO - Seminars in Diagnostic Pathology

JF - Seminars in Diagnostic Pathology

SN - 0740-2570

IS - 6

ER -