The 2015 World Health Organisation Classification of Lung Cancer

Chapter
First Online:
Part of the Molecular Pathology Library book series (MPLB)

Abstract

The World Health Organisation classification of lung cancer is the framework upon which most pathologists worldwide make a standardised and consistent diagnosis of this highly varied and frequently aggressive group of malignant tumours. In the latest edition of the classification, published in 2015, several new changes were introduced. Several of these changes were driven by our greater understanding of the molecular biology of lung cancer and how this is shaping not only our conceptual thinking about these tumours but also how we treat patients suffering from them. Improved radiological imaging and a better understanding of how adenocarcinoma of the lung develops have changed the way we classify particularly early forms of this tumour type. Neuroendocrine tumours, formerly dispersed in various places within the old classifications, are now gathered in one place. Most important of all, from a practical point of view, the classification now includes a diagnostic strategy and an associated nomenclature, for dealing with those small tissue and cytology samples with minimal representation of tumour.

Keywords

WHO classification Lung cancer NSCLC Squamous carcinoma Adenocarcinoma Small cell carcinoma Carcinoid tumour Large cell neuroendocrine carcinoma Adenosquamous carcinoma Sarcomatoid carcinoma Diagnosis 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AN, editors. WHO classification of tumours of the lung, pleura, thymus and heart. Geneva: WHO press; 2015.Google Scholar
  2. 2.
    Travis WD, Brambilla E, Muller-Hermelink HK, et al., editors. World Health Organisation classification of tumours. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC press; 2004.Google Scholar
  3. 3.
    Seidel D, Zander T, Heukamp L, et al. A genomics based classification of human lung tumours. Sci Transl Med. 2013;5:209ra153.Google Scholar
  4. 4.
    Imielinski M, Berger AH, Hammerman P, et al. Mapping the hallmarks of lung adenocarcinoma with massively parallel sequencing. Cell. 2012;150:1107–20.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kris MG, Johnson BE, Berry LD, et al. Using multiplexed assays of oncogenic drivers in lung cancers to select targeted drugs. JAMA. 2014;311:1998–2006.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Greulich H. The genomics of lung adenocarcinoma: opportunities for targeted therapies. Genes Cancer. 2011;1:1200–10.CrossRefGoogle Scholar
  7. 7.
    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. Histological typing of lung and pleural tumours. 3rd ed. Berlin: Springer; 1999.CrossRefGoogle Scholar
  8. 8.
    Travis WD, Brambilla E, Noguchi M, 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;6:244–85.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kerr KM. Pulmonary adenocarcinomas: classification and reporting. Histopathology. 2009;54:12–27.CrossRefPubMedGoogle Scholar
  10. 10.
    Travis WD, Brambilla E, Noguchi M, et al. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med. 2013;137:668–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung: histologic characteristics and prognosis. Cancer. 1995;75:2844–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Yokose T, Suzuki K, Nagai K, et al. Favourable and unfavourable morphological prognostic factors in peripheral adenocarcinoma of the lung 3 cm or less in diameter. Lung Cancer. 2000;29:179–88.CrossRefPubMedGoogle Scholar
  13. 13.
    Sakurai H, Maeshima A, Watanabe S, et al. Grade of stromal invasion in small adenocarcinoma of the lung. Histopathological minimal invasion and prognosis. Am J Surg Pathol. 2004;28:198–206.CrossRefPubMedGoogle Scholar
  14. 14.
    Yim J, Zhu L-C, Chiriboga L, et al. Histologic features are important prognostic indicators in early stages lung adenocarcinomas. Mod Pathol. 2007;20:233–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Yoshizawa A, Motoi N, Riely GJ, 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;24:653–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival? J Thorac Oncol. 2011;6:1496–504.CrossRefPubMedGoogle Scholar
  17. 17.
    Warth A, Muley T, Meister M, et al. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol. 2012;30:1438–46.CrossRefPubMedGoogle Scholar
  18. 18.
    Brambilla CG, Laffaire J, Lantuejoul S, et al. Lung squamous cell carcinomas with basaloid histology represent a specific molecular entity. Clin Cancer Res. 2014;20:5777–86.CrossRefPubMedGoogle Scholar
  19. 19.
    George J, Lim JS, Jang SJ, et al. Comprehensive genomic profiles of small cell lung cancer. Nature. 2015;524:47–67.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fernandez-Cuesta L, Peifer M, Lu X, et al. Frequent mutations in chromatin-remodeling genes in pulmonary carcinoids. Nat Commun. 2014;5:3518r.CrossRefGoogle Scholar
  21. 21.
    Thomas JS, Lamb D, Ashcroft T, Corrin B, Edwards CW, Gibbs AR, et al. How reliable is the diagnosis of lung cancer using small biopsy specimens? Report of a UKCCCR lung cancer working party. Thorax. 1993;48:1135–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Chuang MT, Marchevsky A, Teirstein AS, et al. Diagnosis of lung cancer by fibreoptic bronchoscopy: problems in the histological classification of non-small cell carcinomas. Thorax. 1984;39:175–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Johnson DH, Fehrenbacher L, Novotny WF, et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small cell lung cancer. J Clin Oncol. 2004;22:2184–91.CrossRefPubMedGoogle Scholar
  24. 24.
    Scagliotti GV, Parikh P, Pawel JV, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naïve patients with advanced-stage non-small cell lung cancer. J Clin Oncol. 2008;26:1–10.Google Scholar
  25. 25.
    Felip E, Gridelli C, Baas P, et al. Metastatic non-small-cell lung cancer: consensus on pathology and molecular tests, first-line, second-line, and third-line therapy: 1st ESMO consensus conference in lung cancer; Lugano 2010. Ann Oncol. 2011;22:1507–19.CrossRefPubMedGoogle Scholar
  26. 26.
    Lindeman NI, Cagle PT, Beasley MB, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol. 2013;8:823–59.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kerr KM, Bubendorf L, Edelman MJ, et al. Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer. Ann Oncol. 2014;25:1681–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Edwards SL, Roberts C, McKean ME, et al. Preoperative histological classification of primary lung cancer: accuracy of diagnosis and use of the non-small cell category. J Clin Pathol. 2000;53:537–40.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Loo PS, Thomas SC, Nicolson MC, et al. Subtyping of undifferentiated non-small cell carcinomas in bronchial biopsy specimens. J Thorac Oncol. 2010;5:442–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Mukhopadhyay S, Katzenstein AL. Subclassification of non-small cell lung carcinomas lacking morphologic differentiation on biopsy specimens: utility of an immunohistochemical panel containing TTF-1, napsin A, p63, and CK5/6. Am J Surg Pathol. 2011;35:15–25.CrossRefPubMedGoogle Scholar
  31. 31.
    Terry J, Leung S, Laskin J, et al. Optimal immunohistochemical markers for distinguishing lung adenocarcinomas from squamous cell carcinomas in small tumor samples. Am J Surg Pathol. 2010;34:1805–11.CrossRefPubMedGoogle Scholar
  32. 32.
    Righi L, Graziano P, Fornari A, et al. Immunohistochemical subtyping of nonsmall cell lung cancer not otherwise specified in fine-needle aspiration cytology: a retrospective study of 103 cases with surgical correlation. Cancer. 2011;117:3416–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Wallace WA, Rassl DM. Accuracy of cell typing in nonsmall cell lung cancer by EBUS/EUS-FNA cytological samples. Eur Respir J. 2011;38:911–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Bishop JA, Teruya-Feldstein J, Westra WH, et al. p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. Mod Pathol. 2012;25:405–15.CrossRefPubMedGoogle Scholar
  35. 35.
    Turner BM, Cagle PT, Sainz IM, et al. Napsin A, a new marker for lung adenocarcinoma, is complementary and more sensitive and specific than thyroid transcription factor 1 in the differential diagnosis of primary pulmonary carcinoma: evaluation of 1674 cases by tissue microarray. Arch Pathol Lab Med. 2012;136:163–71.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of PathologyAberdeen Royal InfirmaryAberdeenUK
  2. 2.Department of PathologyAberdeen University Medical School, Aberdeen Royal InfirmaryAberdeenUK

Personalised recommendations