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==Molecular== |
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysi... |
**Exon 19 deletion. |
**Exon 21 L858R. |
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref> |
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 =... |
*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung ... |
**Associated with a poor prognosis.<ref name=pmid22134072>{{Cite journal | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Descha... |
**Amenable to treatment with TKI. |
**See ''[[lung carcinoma with ALK rearrangement]]. |
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. ... |
*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | fi... |
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref> |
==Sign out== |
===Biopsy=== |
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thor... |
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology. |
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS. |
<pre> |
Lung, Right Upper Lobe, Core Biopsy: |
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS. |
Comment: |
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered. |
</pre> |
====Lepidic pattern on biopsy==== |
Important note: lesion '''''must''''' be >=5 mm ''and'' <=30 mm. |
<pre> |
Lung, Left Upper Lobe, Core Biopsy: |
- ADENOCARCINOMA, lepidic pattern. |
Comment: |
The tumour is stains as follows: |
POSITIVE: TTF-1, napsin A, CK7. |
NEGATIVE: p40. |
The findings are in keeping with lepidic pattern adenocarcinoma; the differential diagnosis includes: (1) adenocarcinoma in situ, (2) minimally invasive adenocarcinoma, and (3) invasive adenocarcinoma. |
Lung biomarkers (EGFR, ALK, PDL1, ROS1) have been ordered. |
</pre> |
=====Mucinous adenocarcinoma with noncontributory stains===== |
<pre> |
Lung, Right Upper Lobe, Core Biopsy: |
- ADENOCARCINOMA, MUCINOUS, see comment. |
Comment: |
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered. |
The findings are compatible with a primary or secondary adenocarcinoma; clinical and |
radiologic correlation is required. |
</pre> |
====Block letters==== |
<pre> |
LUNG, LEFT, BIOPSY: |
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN. |
</pre> |
<pre> |
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY: |
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS. |
COMMENT: |
The tumour stains as follows: |
POSITIVE: TTF-1. |
NEGATIVE: p40. |
The immunoprofile is compatible with lung adenocarcinoma. |
</pre> |
<pre> |
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY: |
- INVASIVE ADENOCARCINOMA. |
COMMENT: |
The tumour is positive for TTF-1. |
Tissue will be sent for molecular testing and the results reported as an addendum. |
</pre> |
===Resection=== |
<pre> |
LUNG, LEFT UPPER LOBE, LOBECTOMY: |
- ADENOCARCINOMA WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN |
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE. |
- MARGINS NEGATIVE FOR MALIGNANCY. |
- THREE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/3). |
- PLEASE SEE TUMOUR SUMMARY. |
</pre> |
<pre> |
LUNG, RIGHT UPPER LOBE, LOBECTOMY: |
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