Adenokarzinome der Lunge – die neue Klassifikation

Zusammenfassung

Die neue, interdisziplinäre IASLC/ATS/ERS-Klassifikation des Adenokarzinoms der Lunge hat seit ihrer Publikation im Jahr 2011 eine große Beachtung gefunden. Sie teilt die Adenokarzinome in präinvasive, minimalinvasive und invasive Subtypen ein. Dabei haben die präinvasiven Läsionen atypische adenomatöse Hyperplasie (AAH) und Adenocarcinoma in situ (AIS) zusammen mit dem minimal invasivem Adenokarzinom (MIA) im Falle einer vollständigen Resektion eine exzellente Prognose (100 % Überleben). Zugleich wurde durch die Bestimmung des prädominanten histologischen Subtyps ein reproduzierbares Tumorgrading etabliert, das mittlerweile in mehreren Nachfolgearbeiten bestätigt werden konnte. Der sogenannte Mischtyp, der früher ca. 80 % aller Adenokarzinome ausmachte, wurde dadurch eliminiert. Gleichzeitig wurde die Bezeichnung des bronchioloalveolären Adenokarzinoms bzw. des bronchioloalveolären Wachstums aufgegeben. Hinter diesem Begriff verbargen sich verschiedene Entitäten, die nun eindeutig definiert und den In-situ-Läsionen AAH und AIS bzw. den Non-in-situ-/invasiven Subtypen MIA, lepidisch prädominantes Adenokarzinom (LPA) und invasiv-muzinöses Adenokarzinom (IMA) zugeordnet wurden. Die Klassifikation trägt der Tatsache Rechnung, dass ein Großteil der Adenokarzinome an Biopsien und Zytologien diagnostiziert werden. Sie enthält Empfehlungen für eine gewebesparende molekulare Analyse. Darüber hinaus ergeben sich aus der differenzierten morphologischen Analyse Hinweise auf molekulare Veränderungen einschließlich therapierelevanter Mutationen, die zielgerichtet analysiert werden können. In diesem Artikel werden wesentliche Daten der Klassifikation, die Bestandteil der nächsten WHO Klassifikation der Lungentumoren sein wird, und nachfolgender Publikationen dargestellt.

Abstract

The new, interdiciplinary IASLC/ATS/ERS classification of lung adenocarcinoma has achieved a considerable impact since its publication in the year 2011. It separates tumours into preinvasive, minimally invasive and invasive subtypes. The preinvasive lesions atypical, adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS) together with the minimally invasive adenocarcinoma (MIA), have an excellent prognosis after complete resection with 100 % survival. It enables a reproducible tumour grading by the determination of the predominant histological growth pattern which could be confirmed in several follow-up studies. Thereby the mixed subtype was eliminated which formerly represented about 80 % of all adenocarcinomas. Similarly, the terms bronchioloalveolar adenocarcinoma and bronchioloalveolar tumour growth were eliminated because they represented several distinct entities, specifically the in-situ lesions AAH and ACIS as well as the non-in-situ/invasive tumours like minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma (LPA) and invasive mucinous adenocarcinoma (IMA). Although the classification is based on data from tumour resections it accommodates the fact that most tumours are diagnosed on biopsies and cytological specimens and includes recommendations for an efficient work-up to preserve tissue for molecular testing. Furthermore, the morphological analysis may provide hints for molecular changes including mutations with therapeutic relevance that may enable targeted molecular diagnostics. This review presents essentials facts of the new classification that will be part of the next WHO classification of lung tumors and its follow-up publications.

Schlüsselwörter

Thoraxchirurgie - Tumorwachstum - interdisziplinär

Key words

thoracic surgery - tumour growth - interdisciplinary

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