Article ; Online: Pathologic Processing of Lung Cancer Resection Specimens After Neoadjuvant Therapy.
Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
2023 Volume 37, Issue 1, Page(s) 100353
Abstract: Neoadjuvant treatment of non-small cell lung cancer challenges the traditional processing of pathology specimens. Induction therapy before resection allows evaluation of the efficacy of neoadjuvant agents at the time of surgery. Many clinical trials use ... ...
| Abstract | Neoadjuvant treatment of non-small cell lung cancer challenges the traditional processing of pathology specimens. Induction therapy before resection allows evaluation of the efficacy of neoadjuvant agents at the time of surgery. Many clinical trials use pathologic tumor response, measured as major pathologic response (MPR, ≤10% residual viable tumor [RVT]) or complete pathologic response (CPR, 0% RVT) as a surrogate of clinical efficacy. Consequently, accurate pathologic evaluation of RVT is crucial. However, pathologic assessment has not been uniform, which is particularly true for sampling of the primary tumor, which instead of the traditional processing, requires different tissue submission because the focus has shifted from tumor typing alone to RVT scoring. Using a simulation study, we analyzed the accuracy rates of %RVT, MPR, and CPR of 31 pretreated primary lung tumors using traditional grossing compared with the gold standard of submitting the entire residual primary tumor and identified the minimum number of tumor sections to be submitted to ensure the most accurate scoring of %RVT, MPR, and CPR. Accurate %RVT, MPR, and CPR calls were achieved in 52%, 87%, and 81% of cases, respectively, using the traditional grossing method. Accuracy rates of at least 90% for these parameters require either submission of all residual primary tumor or at least 20 tumor sections. Accurate %RVT, MPR, and CPR scores cannot be achieved with traditional tumor grossing. Submission of the entire primary tumor, up to a maximum of 20 sections, is required for the most accurate reads. |
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| MeSH term(s) | Humans ; Lung Neoplasms/surgery ; Lung Neoplasms/drug therapy ; Carcinoma, Non-Small-Cell Lung/surgery ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Neoadjuvant Therapy/methods ; Lung/pathology ; Treatment Outcome |
| Language | English |
| Publishing date | 2023-10-14 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 645073-8 |
| ISSN | 1530-0285 ; 0893-3952 |
| ISSN (online) | 1530-0285 |
| ISSN | 0893-3952 |
| DOI | 10.1016/j.modpat.2023.100353 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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