"Distinguishing adenocarcinoma from other non-small cell carcinomas has important implications for therapy and requires adequate biopsy samples for molecular testing 13. Studies demonstrate that 18-gauge core needles are highly effective for comprehensive molecular testing, and diagnostic accuracy plateaus at four cores 17. For molecular and genomic analysis, 18G needles yield 4.8–5.7 times more DNA than 20G 26, although 20G cores are adequate in most cases. Complication rates (including pneumothorax, haemorrhage, and haemoptysis) are similar between 18G and 20G needles, and are more strongly influenced by lesion size, depth, and the number of pleural passes 25. A valved coaxial needle can be considered to reduce the number of pleural punctures, also to minimise the risk of systemic air embolism 21. Comprehensive pre-procedural assessment with a tailored approach and technique will maximise patient safety."
"Distinguishing adenocarcinoma from other non-small cell carcinomas has important implications for therapy and requires adequate biopsy samples for molecular testing 13. Studies demonstrate that 18-gauge core needles are highly effective for comprehensive molecular testing, and diagnostic accuracy plateaus at four cores 17. For molecular and genomic analysis, 18G needles yield 4.8–5.7 times more DNA than 20G 26, although 20G cores are adequate in most cases. Complication rates (including pneumothorax, haemorrhage, and haemoptysis) are similar between 18G and 20G needles, and are more strongly influenced by lesion size, depth, and the number of pleural passes 25. A valved coaxial needle can be considered to reduce the number of pleural punctures, also to minimise the risk of systemic air embolism 21. Comprehensive pre-procedural assessment with a tailored approach and technique will maximise patient safety."
"histological pattern: either pure lepidic or predominant lepidic growth pattern, with neoplastic cells along with the alveolar structures, with ≤5 mm of stromal invasion. These lesions should not show necrosis, lymphatic, vascular, or pleural invasion."
"adenocarcinoma, NOS"
"PET-CT definition of the gross tumour volume is commonly smaller than on CT, in ~15% of patients 7, therefore the T component of the TNM staging must be measured on CT or updated by the pathological staging"
Expected headings
"FDG PET-CT"
"Adenocarcinoma of the lung is typified by glandular differentiation or mucin production and is the most common histologic type of lung cancer. The incidence is rising globally, particularly in women, East Asians and non-smokers. Non-smokers often present with adenocarcinoma spectrum lesions, progressing slowly from benign ground-glass nodules to invasive adenocarcinoma, whereas smokers present with more aggressive, solid and invasive de novo tumours 15."
"This introduces new concepts, advances and minor differences compared to the 2011 International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) re-classification of lung adenocarcinoma and adenocarcinoma spectrum:"
"has several subtypes: the most common subtype is non-mucinous and, rarely, mucinous or mixed subtypes"
"This article provides a broad overview of lung adenocarcinoma; for further details on each subtype, please refer to the specific articles listed below."
"About one third are asymptomatic at diagnosis; when symptoms are present they are nonspecific:"
"Carcinogenetic pathways differ between smokers and non-smokers: in nonsmokers, lepidic lung adenocarcinomas usually begin in the terminal respiratory unit (TRU), progressing to a micropapillary pattern; they are often driven by EGFR mutations and respond to tyrosine kinase inhibitors. In smokers, tumours can originate from either the TRU or central airway compartment, they have variable histology (often developing into acinar/solid and mucinous tumours), are often associated with KRAS mutations and have a higher incidence of TP53 transversions, which promote both tumour progression and aggressive behaviour 12. Smokers are more likely to develop invasive adenocarcinomas that arise de novo, with a short latency from initiation to detection, advanced stage at diagnosis and poor differentiation."
"Adenocarcinoma spectrum lesions can be multiple, with an incidence of 11% over 7 years in one study 18; ~40% were synchronous and 60% metachronous. This has implications for management: the morphology and stage of adenocarcinoma spectrum lesions can only be fully assessed if the entire lesion is examined, which requires complete surgical resection. Lesions in separate lobes cannot all be managed by lobectomy, so sublobar resections are an important option."