Does Lung Adenocarcinoma Subtype Predict Patient Survival

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Does Lung Adenocarcinoma Subtype Predict Patient Survival Does Lung Adenocarcinoma Subtype Predict Patient Survival?: A Clinicopathologic Study Based on the New International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Lung Adenocarcinoma Classification Prudence A. Russell, MBBS, FRCPA, Zoe Wainer, BMBS, Gavin M. Wright, MBBS, FRACS, Marissa Daniels, MBBS, Matthew Conron, MBBS, FRACP, Richard A. Williams, MBBS, FRCPA, PhD Journal of Thoracic Oncology Volume 6, Issue 9, Pages 1496-1504 (September 2011) DOI: 10.1097/JTO.0b013e318221f701 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Morphology of adenocarcinoma in situ and minimally invasive adenocarcinoma with VVG stains. A, Pattern 1 with VVG stains comprises continuous black staining in thickened alveolar walls representing intact elastic fibers often associated with diminution in size of alveolar spaces, indicative of the absence of stromal invasion (VVG, ×100). B, Pattern 2 with VVG stains comprises thin, discrete but overlapping elastic fibers in alveolar walls only slightly thicker than those in the adjacent lung but thinner than pattern 1 (VVG, ×200). C, A solid area of nonlepidic growth in a tumor that otherwise shows predominant lepidic growth as seen with VVG stains (VVG, ×20). D, With VVG stains the solid area shows red-yellow desmoplastic tumor stroma, bundles of black broken elastic fibers, and infiltrating acinar pattern adenocarcinoma, indicative of stromal invasion (VVG, ×400). VVG, Verhoff Van Gieson. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 At low-power magnification, we drew a line around the edges of the area of nonlepidic growth at its interface with the area of lepidic growth and measured the size of the area of nonlepidic growth in its longest dimension on the glass slide (VVG, ×20). VVG, Verhoff Van Gieson. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Morphology of adenocarcinoma subtypes and variants. A, Acinar pattern adenocarcinoma comprises jagged haphazardly arranged glands with or without luminal or cytoplasmic mucin infiltrating desmoplastic tumor stroma (HE, ×200). B, With VVG stains the papillae of papillary pattern adenocarcinoma show no black elastic fibers in their fibrovascular cores indicative of stromal invasion (VVG, ×200). C, Micropapillary pattern adenocarcinoma comprises small papillary tufts of tumor cells without fibrovascular cores either lying apparently free in alveolar spaces or surrounded by thin fibrous septa (HE, ×200). D, Solid with mucin pattern adenocarcinoma comprises nests of tumor cells that show intracytoplasmic mucin with Alcian blue-Periodic Acid Schiff stains with diastase differentiation (AB-PASD, ×200). E, Invasive mucinous adenocarcinoma shows peripheral foci of lepidic growth of columnar or goblet cells with abundant intracellular mucin admixed with invasive adenocarcinoma patterns (HE, ×100). VVG, Verhoff Van Gieson; HE, hematoxylin and eosin. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 The largest minimally invasive adenocarcinoma showed predominant lepidic growth with an intact elastic framework seen on VVG stains and a 4 mm area of nonlepidic growth comprising infiltrating acinar adenocarcinoma, desmoplastic tumor stroma, and irregular bundles of elastic fibers (VVG, ×40). VVG, Verhoff Van Gieson. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 Correlation of 5-year survival with the predominant histologic subtype revealed significant differences in survival (p < 0.0001) between 18 cases of AIS, MIA, and lepidic-predominant tumors (93% 5-year survival), 26 cases of papillary-predominant (71% 5-year survival), 84 cases of acinar-predominant (68% 5-year survival), 49 cases of solid with mucin-predominant (39% 5-year survival), and 14 cases of micropapillary-predominant (38% 5-year survival) adenocarcinoma. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6 The small number of adenocarcinoma variants, invasive mucinous adenocarcinoma, and colloid adenocarcinoma, each had an intermediate to poor prognosis of 51% 5-year survival. Journal of Thoracic Oncology 2011 6, 1496-1504DOI: (10.1097/JTO.0b013e318221f701) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions