Histological scoring for small lung adenocarcinomas 2 cm or less in diameter: a reliable prognostic indicator.
OBJECTIVE
Lung adenocarcinomas 2 cm or less in diameter were studied to develop histologic criteria predicting the outcome.


METHODS
We reviewed 510 consecutive lung adenocarcinomas 2 cm or less in diameter and assessed three histologic parameters to implement a histologic scoring system: lymphovascular invasion, maximum diameter of the nonbronchioloalveolar carcinoma (BAC) component, and percentage of the solid, cribriform, and/or papillary component in the entire tumor volume (%solid/cribriform/papillary). One point was given to each of lymphovascular invasion-positive, non-BAC >10 mm and %solid/cribriform/papillary > or =30%, and by the sum of these points, a score of 0 to 3 was assigned for each tumor. We also evaluated minimally invasive adenocarcinomas comprising non-BAC < or =5 mm, Sakurai grades 1 and 2.


RESULTS
Five-year disease-free survival rates of 287 patients with a histologic score of 0, 69 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 98.9%, 92.4%, 78.4%, and 54.0%, respectively. The 510 tumors included 129 noninvasive and 127 minimally invasive adenocarcinomas. None of these tumors recurred. In remaining 254 patients with overtly invasive adenocarcinomas, 5-year disease-free survival rates in 51 with a histologic score of 0, 49 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 95.9%, 89.2%, 79.4%, and 54.2%, respectively.


CONCLUSIONS
The histologic scoring system comprising lymphovascular invasion-positive, non-BAC >10 mm and %solid/cribriform/papillary > or =30% is able to predict the outcome of lung adenocarcinomas 2 cm or less in diameter not only in all cases but also in overtly invasive adenocarcinomas. Minimally invasive adenocarcinomas did not recur in this large series.
Maeshima
Akiko Miyagi
AM
Clinical Laboratory Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuoku, 104-0045 Tokyo, Japan. akmaeshi@ncc.go.jp
Tochigi
Naobumi
N
Yoshida
Akihiko
A
Asamura
Hisao
H
Tsuta
Koji
K
Tsuda
Hitoshi
H
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult