Lung Cancer Pathology Pattern Predicts Recurrence

A specific pattern found in the tumor pathology of some lung cancer patients is a strong predictor of recurrence.

The pattern will help surgeons identify which patients are more likely to benefit from less radical lung-sparing surgery, and which patients will benefit from more extensive surgery.

Pathologists at the Memorial Sloan-Kettering Cancer Center (New York, NY, USA) evaluated the clinical characteristics and pathology information of 734 patients who had surgery for early-stage adenocarcinoma, the most common subtype of non-small-cell lung cancer. The scientists evaluated the prognostic utility of a classification, called micropapillary (MIP) morphology, for patients with small, early-stage lung adenocarcinomas.

All available hematoxylin and eosin-stained slides were reviewed by two pathologists. A minimum of two hematoxylin and eosin stained slides were reviewed per patient; the median was four; and ranged from 2 to 10 slides/patient. Each tumor was evaluated by comprehensive histologic subtyping, and the percentage of each histologic component was recorded in 5% increments. They found that tumors in 40% of those patients exhibited an abnormal MIP cell pattern strongly associated with cancer recurrence after surgery.

The findings suggest that limited resection may not be appropriate for patients with the MIP pattern, as they were found to have a 34% risk of the cancer returning within five years after lung-sparing surgery, or limited resection, in which the tumor is removed by minimally invasive means and lung function is preserved. In contrast, patients with the MIP pattern who underwent lobectomy, the standard approach in which up to a third of the lung is removed along with the tumor, had only a 12% incidence of recurrence over a five-year period.

The scientists at Memorial Sloan-Kettering are working to develop new technology that can be used to precisely identify which tumors have the MIP pattern before or during surgery. This will not only help doctors recommend the most effective surgical approach for each patient, but will result in fewer patients requiring additional treatment. The study was published on August 7, 2013, in the Journal of the National Cancer Institute.

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