Publication: Grading lung neuroendocrine tumors: Controversies in search of a solution
Authors
Pelosi, Giuseppe ; Pattini, Linda ; Morana, Giovanni ; Fabbri, Alessandra ; Faccinetto, Alex ; Fazio, Nicola ; Valeri, Barbara ; Sonzogni, Angelica
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Publisher
Universidad de Murcia. Departamento de Biología Celular e Histología
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DOI
DOI: 10.14670/HH-11-822
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info:eu-repo/semantics/article
Description
Abstract
Background. Pathological grading of tumors
is a way to measure biological aggressiveness. In lung
neuroendocrine tumors (NET), grading is tautologically
included into the current 2015 WHO histologic
classification. Little is known, however, about
alternative grading systems in lung NET.
Methods. Through an extensive search of the English
literature on lung NET (updated to April 2016), the
following key questions were addressed: a) current
concepts of grading; b) clinicians’ requests for grading;
c) functional parameters for grading; d) Ki-67 labeling
index (LI) for grading; e) towards an effective pathology
grading system.
Results. There is some room for inconsistency in the
histologic classification of lung NET, likely due to the
varying attribution of defining criteria. Innovative
diffusion-weighted imaging upon magnetic resonance or
molecular analysis could help separate indolent from
aggressive lung NET, thus integrating a grading
approach other than histology. Troubles in the clinical
handling of metastatic or individual tumors when relying
on morphology alone support the development of a lungspecific grading system for the more accurate prediction
of prognosis and planning therapy in individual patients.
To integrate the 2015 WHO classification using
innovative grading based on Ki-67 LI, mitotic count and
necrosis, a new proposal is emerging where three
categories of lung NET are identified, namely Lu-NET
G1, Lu-NET G2 and Lu-NET G3, which would allow
tumors with similar behavior and therapy to be better
handled according to their own biological potential.
Conclusion. A new formulation of lung NET grading
could have clinical relevance for the individual handling
of patients.
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