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J Thorac Oncol. 2019 Sep 20. pii: S1556-0864(19)33232-0. doi: 10.1016/j.jtho.2019.08.2506. [Epub ahead of print]

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

Author information

1
Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London.
2
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA.
3
Medical School, University of Western Australia, Perth Australia.
4
Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, Illinois, USA.
5
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massacheusetts, USA.
6
Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille, France.
7
Department of Radiology, The University of Chicago, Chicago, Illinois, USA.
8
International Agency for Research on Cancer (IARC/WHO), Section of Genetics, Lyon, France.
9
Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massacheusetts, USA.
10
Cardiothoracic Surgery, NYU Langone Health, New York, New York. USA.
11
Department of Cellular Pathology, University Hospital of Wales, School of Medicine, Cardiff University, UK.
12
Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
13
Department of Pathology, Mount Sinai Medical Center, New York, New York, USA.
14
Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
15
Department of Pathology & Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont, USA.
16
Department of Pathology, Brigham and Women's Hospital, Boston, Massacheusetts, USA.
17
Dept of Pathology, Vancouver General Hospital, Vancouver, BC, Canad.
18
Owkin Inc.
19
Department of Pathology University of Pittsburgh Medical Center, Pennsylvania, USA.
20
Division of Thoracic Surgery, Princess Margaret Cancer Centre, Toronto, Canada.
21
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
22
Department of Cellular Pathology, Cardiff and Vale UHB, Cardiff, Wales, UK.
23
Center for Thoracic Oncology, Mount Sinai Health System, New York, New York, USA.
24
Department of Pathology, Tokyo Women's Medical University, Yachiyo Medical Center, Tokyo, Japan.
25
Department of Pathology, University of Chicago, Chicago, Illinois, USA.
26
Department of Anatomical Pathology, SA Pathology and Flinders University, Adelaide, Australia.
27
Department of Biopathology and of Translational Research and Innovation, CNR MESOPATH, Centre Leon Berard Lyon, and Grenoble Alpes University, France.
28
Department of Pathology, New York University Langone Health, New York, new York, USA.
29
Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
30
Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France.
31
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
32
Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
33
Pulmonary and Thoracic Oncology Department, Univ Lille, CHU Lille, France.
34
Université Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, France.
35
Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona.
36
Department of Pathology, University Health Network , Princess Margaret Cancer Centre, Toronto, Canada.
37
Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium.
38
CHU Nancy, Université Lorraine, Nancy, France.
39
Department of Pathology, UZ Leuven, Leuven, Belgium.
40
International Agency for Research on Cancer (IARC), Lyon, France.
41
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
42
Institut Curie, Institut du Thorax Curie Montsouris, Paris, France.
43
MESOPATH Centre Leon Berard, Lyon, France.

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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