Zusammenfassung
Im Vergleich mit anderen Tumorentitäten liegt für die Karzinome der Lunge aktuell noch kein einheitliches, allgemein akzeptiertes Gradingsystem mit klar definierten Kriterien und klinischer Signifikanz vor. In der 4. Auflage der WHO-Klassifikation von Tumoren der Lunge, der Pleura, des Thymus und des Herzens ist kein einheitliches Grading für pulmonale Adeno-, Plattenepithelkarzinome oder seltenere Tumorentitäten angegeben. Für die Adenokarzinome werden seit der 2011 publizierten IASLC/ATS/ERS-Klassifikation 5 unterschiedliche Subtypen mit signifikant unterschiedlicher Prognose vorgeschlagen. Daraus resultiert ein rein histologisches Grading, das üblicherweise an Resektaten eingesetzt wird. Bei den Plattenepithelkarzinomen wurde zwar die Anzahl der unterschiedlichen histologischen Subtypen in der neuen WHO-Klassifikation gegenüber früheren Versionen reduziert, es resultiert daraus jedoch kein einheitliches Gradingsystem. In aktuelleren Publikationen werden „nesting“ und „budding“ als wesentliche histologische Kriterien für ein Grading von Plattenepithelkarzinomen vorgeschlagen. Die neuroendokrinen Tumoren (NET) der Lunge werden in einer getrennten Arbeit dieses Themenhefts im Vergleich mit den NET anderer Organe abgehandelt.
Bestimmte seltenere Tumortypen sind per definitionem „high grade“: kleinzellige, großzellige, pleomorphe Karzinome, Karzinosarkome und pulmonale Blastome. In der Zukunft ist zu erwarten, dass diese Entwicklungen weiter verstetigt und verfeinert werden, z. B. durch Einbeziehung weiterer Subtypen bei den Adenokarzinomen und ggf. auch zytologischer und/oder nukleärer Kriterien bei Adeno- und/oder Plattenepithelkarzinomen.
Abstract
In comparison with other tumor entities there is no common generally accepted grading system for lung cancer with clearly defined criteria and clinical relevance. In the recent fourth edition of the World Health Organization (WHO) classification from 2015 of tumors of the lungs, pleura, thymus and heart, there is no generally applicable grading for pulmonary adenocarcinomas, squamous cell carcinomas or rarer forms of carcinoma. Since the new IASLC/ATS/ERS classification of adenocarcinomas published in 2011, 5 different subtypes with significantly different prognosis are proposed. This results in an architectural (histologic) grading, which is usually applied to resection specimens. For squamous cell carcinoma the number of different histological subtypes in the new WHO classification was reduced compared to earlier versions but without a common grading system. In recent publications nesting and budding were proposed as the main (histologic) criteria for a grading of squamous cell carcinomas. The grading of neuroendocrine tumors (NET) of the lungs in comparison with NET in other organs is presented in a separate article in this issue. Certain rare tumor types are high grade per definition: small cell, large cell and pleomorphic carcinomas, carcinosarcomas and pulmonary blastomas. In the future it is to be expected that these developments will be further refined, e. g. by adding further subtypes for adenocarcinomas and cytologic and/or nuclear criteria for adenocarcinoma and/or squamous cell carcinomas.
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R. M. Bohle und P. A. Schnabel geben an, dass kein Interessenkonflikt besteht.
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Bohle, R.M., Schnabel, P.A. Grading von Lungenkarzinomen. Pathologe 37, 314–319 (2016). https://doi.org/10.1007/s00292-016-0175-7
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DOI: https://doi.org/10.1007/s00292-016-0175-7