EURACAN/IASLC Proposals for updating the histologic classification of pleural mesothelioma: Towards a more multidisciplinary approach Journal Article


Authors: Nicholson, A. G.; Sauter, J. L.; Nowak, A. K.; Kindler, H. L.; Gill, R. R.; Remy-Jardin, M.; Armato, S. G. 3rd; Fernandez-Cuesta, L.; Bueno, R.; Alcala, N.; Foll, M.; Pass, H.; Attanoos, R.; Baas, P.; Beasley, M. B.; Brcic, L.; Butnor, K. J.; Chirieac, L. R.; Churg, A.; Courtiol, P.; Dacic, S.; De Perrot, M.; Frauenfelder, T.; Gibbs, A.; Hirsch, F. R.; Hiroshima, K.; Husain, A.; Klebe, S.; Lantuejoul, S.; Moreira, A.; Opitz, I.; Perol, M.; Roden, A.; Roggli, V.; Scherpereel, A.; Tirode, F.; Tazelaar, H.; Travis, W. D.; Tsao, M. S.; van Schil, P.; Vignaud, J. M.; Weynand, B.; Lang-Lazdunski, L.; Cree, I.; Rusch, V. W.; Girard, N.; Galateau-Salle, F.
Article Title: EURACAN/IASLC Proposals for updating the histologic classification of pleural mesothelioma: Towards a more multidisciplinary approach
Abstract: Introduction: Molecular and immunologic breakthroughs are transforming the management of thoracic cancer, although advances have not been as marked for malignant pleural mesothelioma where pathologic diagnosis has been essentially limited to three histologic subtypes. Methods: A multidisciplinary group (pathologists, molecular biologists, surgeons, radiologists, and oncologists), sponsored by European Network for Rare Adult Solid Cancers/International Association for the Study of Lung Cancer, 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 malignant pleural mesotheliomas should be routinely undertaken; (4) favorable/unfavorable histologic characteristics should be routinely reported; (5) clinically relevant molecular data (programmed death ligand 1, BRCA 1 associated protein 1 [BAP1], and cyclin dependent kinase inhibitor 2A) 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 three 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; and (14) systematic screening of all patients for germline mutations is not recommended, in the absence of a family history suspicious for BAP1 syndrome. Conclusions: 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. © 2019 International Association for the Study of Lung Cancer
Keywords: adult; human tissue; treatment response; major clinical study; clinical feature; bevacizumab; treatment duration; cancer grading; ipilimumab; ticilimumab; cancer immunotherapy; classification; lung resection; lung cancer; pathology; brca1 protein; pleura mesothelioma; mesothelioma; sarcomatoid carcinoma; cyclin dependent kinase inhibitor 2a; cancer classification; pleurectomy; programmed death 1 ligand 1; germline mutation; pleura cavity; multidisciplinary; cancer prognosis; nivolumab; human; male; priority journal; article; nintedanib; durvalumab
Journal Title: Journal of Thoracic Oncology
Volume: 15
Issue: 1
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2020-01-01
Start Page: 29
End Page: 49
Language: English
DOI: 10.1016/j.jtho.2019.08.2506
PUBMED: 31546041
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    724 Rusch
  2. William D Travis
    581 Travis
  3. Jennifer Lynn Sauter
    38 Sauter