Evolving concepts in the pathology and computed tomography imaging of lung adenocarcinoma and bronchioloalveolar carcinoma.
OBJECTIVE
To review recent advances in pathology and computed tomography (CT) of lung adenocarcinoma and bronchioloalveolar carcinoma (BAC).


METHODS
A pathology/CT review panel of pathologists and radiologists met during a November 2004 International Association for the Study of Lung Cancer/American Society of Clinical Oncology consensus workshop in New York. The purpose was to determine if existing data was sufficient to propose modification of criteria for adenocarcinoma and BAC as newly published in the 2004 WHO Classification of Lung Tumors, and to address the pathologic/radiologic concept of diffuse/multicentric BAC.


RESULTS
Solitary small, peripheral BACs have an excellent prognosis. Most lung adenocarcinomas with a BAC pattern are not pure BAC, but rather adenocarcinoma, mixed subtype with invasive patterns. This applies to tumors presenting with a diffuse/multinodular as well as solitary nodule pattern. The percent of BAC versus invasive components in lung adenocarcinomas appears to be prognostically important. However, a consensus definition of "minimally invasive" BAC with a favorable prognosis could not be achieved. While recognition of a BAC component is possible, the diagnosis of BAC with exclusion of invasive adenocarcinoma cannot be made by small biopsy or cytology specimens.


CONCLUSIONS
There is a need to work toward a mutual understanding and consensus between pathologists, clinicians, and researchers with the use of the term BAC versus adenocarcinoma. Future studies should make some attempt to quantitate these components and/or other features such as size of scar, size of invasive component, or pattern of invasion. Hopefully, this work will allow definition of a category of adenocarcinoma, mixed subtype with predominant BAC/minimal invasion and a favorable prognosis.
Travis
William D
WD
Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. travisw@mskcc.org
Garg
Kavita
K
Franklin
Wilbur A
WA
Wistuba
Ignacio I
II
Sabloff
Bradley
B
Noguchi
Masayuki
M
Kakinuma
Ryutaro
R
Zakowski
Maureen
M
Ginsberg
Michelle
M
Padera
Robert
R
Jacobson
Francine
F
Johnson
Bruce E
BE
Hirsch
Fred
F
Brambilla
Elizabeth
E
Flieder
Douglas B
DB
Geisinger
Kim R
KR
Thunnisen
Frederik
F
Kerr
Keith
K
Yankelevitz
David
D
Franks
Teri J
TJ
Galvin
Jeffrey R
JR
Henderson
Douglas W
DW
Nicholson
Andrew G
AG
Hasleton
Philip S
PS
Roggli
Victor
V
Tsao
Ming-Sound
MS
Cappuzzo
Federico
F
Vazquez
Madeline
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed