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EURACAN/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach


Nicholson, Andrew G; Sauter, Jennifer L; Nowak, Anna K; Kindler, Hedy L; Gill, Ritu R; Remy-Jardin, Martine; et al; Frauenfelder, Thomas; Opitz, Isabelle (2020). EURACAN/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach. Journal of Thoracic Oncology, 15(1):29-49.

Abstract

INTRODUCTION
Molecular and immunologic breakthroughs are transforming the management of thoracic cancer, although advances have not been as marked for malignant pleural mesothelioma (MPM) where pathologic diagnosis has been essentially limited to three histologic subtypes.
METHODS
A multidisciplinary group (pathologists, molecular biologists, surgeons, radiologists and oncologists), sponsored by EURACAN/IASLC met in 2018, to critically review the current classification.
RESULTS
Recommendations include: 1) classification should be updated to include architectural patterns, and stromal and cytologic features that refine prognostication 2) subject to data accrual, malignant mesothelioma in situ could be an additional category, 3) grading of epithelioid MPMs should be routinely undertaken, 4) favorable/unfavorable histologic characteristics should be routinely reported, 5) clinically relevant molecular data (PD-L1, BAP1, CDKN2A) should be incorporated into reports, if undertaken, 6) other molecular data should be accrued as part of future trials 7) resection specimens (i.e. extended pleurectomy/decortication and extrapleural pneumonectomy) should be pathologically staged with smaller specimens being clinically staged, 8) ideally, at least 3 separate areas should be sampled from the pleural cavity, including areas of interest identified on pre-surgical imaging, 9) image-acquisition protocols/imaging terminology should be standardized to aid research/refine clinical staging, 10) multidisciplinary tumor boards should include pathologists to ensure appropriate treatment options are considered, 11) all histologic subtypes should be considered potential candidates for chemotherapy, 12) patients with sarcomatoid or biphasic mesothelioma should not be excluded from first line clinical trials unless there is a compelling reason, 13) tumor subtyping should be further assessed in relation to duration of response to immunotherapy, 14) systematic screening of all patients for germline mutations is not recommended, in the absence of a family history suspicious for BAP1 syndrome.
CONCLUSION
These multidisciplinary recommendations for pathology classification and application will allow more informative pathologic reporting and potential risk stratification, to support clinical practice, research investigation and clinical trials.

Abstract

INTRODUCTION
Molecular and immunologic breakthroughs are transforming the management of thoracic cancer, although advances have not been as marked for malignant pleural mesothelioma (MPM) where pathologic diagnosis has been essentially limited to three histologic subtypes.
METHODS
A multidisciplinary group (pathologists, molecular biologists, surgeons, radiologists and oncologists), sponsored by EURACAN/IASLC met in 2018, to critically review the current classification.
RESULTS
Recommendations include: 1) classification should be updated to include architectural patterns, and stromal and cytologic features that refine prognostication 2) subject to data accrual, malignant mesothelioma in situ could be an additional category, 3) grading of epithelioid MPMs should be routinely undertaken, 4) favorable/unfavorable histologic characteristics should be routinely reported, 5) clinically relevant molecular data (PD-L1, BAP1, CDKN2A) should be incorporated into reports, if undertaken, 6) other molecular data should be accrued as part of future trials 7) resection specimens (i.e. extended pleurectomy/decortication and extrapleural pneumonectomy) should be pathologically staged with smaller specimens being clinically staged, 8) ideally, at least 3 separate areas should be sampled from the pleural cavity, including areas of interest identified on pre-surgical imaging, 9) image-acquisition protocols/imaging terminology should be standardized to aid research/refine clinical staging, 10) multidisciplinary tumor boards should include pathologists to ensure appropriate treatment options are considered, 11) all histologic subtypes should be considered potential candidates for chemotherapy, 12) patients with sarcomatoid or biphasic mesothelioma should not be excluded from first line clinical trials unless there is a compelling reason, 13) tumor subtyping should be further assessed in relation to duration of response to immunotherapy, 14) systematic screening of all patients for germline mutations is not recommended, in the absence of a family history suspicious for BAP1 syndrome.
CONCLUSION
These multidisciplinary recommendations for pathology classification and application will allow more informative pathologic reporting and potential risk stratification, to support clinical practice, research investigation and clinical trials.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Thoracic Surgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Oncology
Health Sciences > Pulmonary and Respiratory Medicine
Language:English
Date:1 January 2020
Deposited On:01 Nov 2019 12:34
Last Modified:29 Jul 2020 11:36
Publisher:Elsevier
ISSN:1556-0864
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.jtho.2019.08.2506
PubMed ID:31546041

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