Abstracts From the Pulmonary Pathology Society 2024 Biennial Meeting

The year 2015 marked the 20-year anniversary of the Pulmonary Pathology Society (PPS). It was founded in 1995, under the leadership of William Travis, MD (USA), with Thomas Colby, MD (USA); Samuel Hammar, MD (USA); Bruce Mackay, MD (USA); Helmut Popper, MD (Austria); and Osamu Matsubara, MD, PhD (Japan), among others. The PPS elected Dr Thomas Colby as its first president. Today, the PPS is an international society with 300 members from more than 25 countries. The PPS is a partner society with the College of American Pathologists (CAP) and the 2 organizations have cosponsored a number of educational activities and courses together at the CAP annual meeting and elsewhere for the past decade. The PPS has held an annual companion meeting at the United States and Canadian Academy of Pathology meeting each year since 1996 and a stand-alone meeting every 2 years. The 2015 PPS Biennial Meeting was cosponsored by the CAP and was held in San Francisco in June. Hosted by now past-president Kevin O. Leslie, MD, the 3-day meeting was likened by one colleague as ‘‘science fiction coming true.’’ The lecture lineup, carefully selected by an all-star Program Committee chaired by Philip T. Cagle, MD, a former president of the PPS, provided hot-off-the-press insight into one pulmonary pathology topic after another. It is from those presentations that most of the articles included in Part I of this ARCHIVES Special Section arise. As president of the PPS, it is a privilege and a pleasure to present this Special Section. Erik Thunnissen, MD, PhD, and colleagues provide a sophisticated discussion of how we can reduce medical error by identifying ex vivo artifacts in lung specimens; Maxwell Smith, MD, updates our understanding of interstitial lung disease; and Anja Roden, MD, and Eunhee Yi, MD, expand our understanding of pulmonary Langerhans cell histiocytosis. Further, Aliya Husain, MD, and Edward Garrity, MD, discuss airway changes in patients with lung transplants; Eric Bernicker, MD, describes how a team of clinicians, basic scientists, and pathologists can work together to make true personalized lung cancer therapy a reality; and Keith Kerr, BSc, MB, ChB, FRCPath, FRCPE, and Marianne Nicolson, MD, FRCP, provide a fascinating examination of PD-L1 as the ‘‘third dimension’’ of lung cancer therapy. We had a number of abstracts presented at the meeting that are included in this Special Section as well. Part II will continue the discussion of lung pathology from other PPS members. Many thanks to these pulmonary pathologists for sharpening the cutting edge of pulmonary pathology diagnosis and therapy.

Presented here are the scientific abstracts from the Pulmonary Pathology Society (PPS) Biennial Meeting, which took place in June 2022 in Cork, Ireland. This meeting of pulmonary pathologists from around the world was assembled under the direction and leadership of Sanja Dacic, MD, PhD, then president of the PPS. All abstracts were reviewed for scientific content by Lida Hariri, MD, PhD, and Andrew Nicholson, DM, as well as members of the abstract review committee, Sabina Berezowska, MD, and Sonja Klebe, MD, PhD, prior to their acceptance.

Presented here are the scientific abstracts from the Pulmonary Pathology Society (PPS) Biennial Meeting, which took place in June 2019 in Dubrovnik, Croatia. This meeting of pulmonary pathologists from around the world was assembled under the direction and leadership of Mary Beth Beasley, MD, then president of the PPS. All abstracts were reviewed for scientific content by Mari Mino-Kenudson, MD, and Andre Moreira, MD, prior to their acceptance.

The pathologic diagnosis of usual interstitial pneumonia (UIP) remains a challenging area, and application of histologic UIP guidelines has proved difficult. To understand current practice approaches by pulmonary pathologists for the histologic diagnosis of UIP and other fibrotic interstitial lung diseases (ILDs). The Pulmonary Pathology Society (PPS) ILD Working Group developed and sent a 5-part survey on fibrotic ILD electronically to the PPS membership. One hundred sixty-one completed surveys were analyzed. Of the respondents, 89% reported using published histologic features in clinical guidelines for idiopathic pulmonary fibrosis (IPF) in their pathologic diagnosis; however, there was variability in reporting terminology, quantity and quality of histologic features, and the use of guideline categorization. Respondents were very likely to have access to pulmonary pathology colleagues (79%), pulmonologists (98%), and radiologists (94%) to discuss cases. Half of respondents reported they may alter their pathologic diagnosis based on additional clinical and radiologic history if it is pertinent. Airway-centered fibrosis, granulomas, and types of inflammatory infiltrates were considered important, but there was poor agreement on how these features are defined. There is significant consensus among the PPS membership on the importance of histologic guidelines/features of UIP. There are unmet needs for (1) consensus and standardization of diagnostic terminology and incorporation of recommended histopathologic categories from the clinical IPF guidelines into pathology reports, (2) agreement on how to incorporate into the report relevant clinical and radiographic information, and (3) defining the quantity and quality of features needed to suggest alternative diagnoses.

Presented here are the Scientific Abstracts from the Biennial Pulmonary Pathology Society (PPS) Meeting, which took place in June 2013 in Grenoble, France. This meeting of pulmonary specialists from around the world was assembled under the direction and leadership of Elisabeth Brambilla, MD, then president of the PPS. All abstracts were reviewed for scientific content by an abstract review committee prior to their acceptance.

Environmental lung and pleural disease (Pulmonary Pathology Society)

Rapid advancements in the understanding and manipulation of tumor-immune interactions have led to the approval of immune therapies for patients with non-small cell lung cancer. Certain immune checkpoint inhibitor therapies require the use of companion diagnostics, but methodologic variability has led to uncertainty around test selection and implementation in practice. To develop evidence-based guideline recommendations for the testing of immunotherapy/immunomodulatory biomarkers, including programmed death ligand-1 (PD-L1) and tumor mutation burden (TMB), in patients with lung cancer. The College of American Pathologists convened a panel of experts in non-small cell lung cancer and biomarker testing to develop evidence-based recommendations in accordance with the standards for trustworthy clinical practice guidelines established by the National Academy of Medicine. A systematic literature review was conducted to address 8 key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, recommendations were created from the available evidence, certainty of that evidence, and key judgments as defined in the GRADE Evidence to Decision framework. Six recommendation statements were developed. This guideline summarizes the current understanding and hurdles associated with the use of PD-L1 expression and TMB testing for immune checkpoint inhibitor therapy selection in patients with advanced non-small cell lung cancer and presents evidence-based recommendations for PD-L1 and TMB testing in the clinical setting.

The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.

We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers.

Response by the organizers of the Helsinki criteria updates 2014: Criteria for asbestos-related diseases need periodic updates.

The Pulmonary Pathology Society's Future: Busy and Bright.

Asbestosis is defined as diffuse pulmonary fibrosis caused by the inhalation of excessive amounts of asbestos fibers. Pathologically, both pulmonary fibrosis of a particular pattern and evidence of excess asbestos in the lungs must be present. Clinically, the disease usually progresses slowly, with a typical latent period of more than 20 years from first exposure to onset of symptoms. IDIOPATHIC PULMONARY FIBROSIS: The pulmonary fibrosis of asbestosis is interstitial and has a basal subpleural distribution, similar to that seen in idiopathic pulmonary fibrosis, which is the principal differential diagnosis. However, there are differences between the 2 diseases apart from the presence or absence of asbestos. First, the interstitial fibrosis of asbestosis is accompanied by very little inflammation, which, although not marked, is better developed in idiopathic pulmonary fibrosis. Second, in keeping with the slow tempo of the disease, the fibroblastic foci that characterize idiopathic pulmonary fibrosis are infrequent in asbestosis. Third, asbestosis is almost always accompanied by mild fibrosis of the visceral pleura, a feature that is rare in idiopathic pulmonary fibrosis. RESPIRATORY BRONCHIOLITIS: Asbestosis is believed to start in the region of the respiratory bronchiole and gradually extends outward to involve more and more of the lung acinus, until the separate foci of fibrosis link, resulting in the characteristically diffuse pattern of the disease. These early stages of the disease are diagnostically problematic because similar centriacinar fibrosis is often seen in cigarette smokers and is characteristic of mixed-dust pneumoconiosis. Fibrosis limited to the walls of the bronchioles does not represent asbestosis. Histologic evidence of asbestos inhalation is provided by the identification of asbestos bodies either lying freely in the air spaces or embedded in the interstitial fibrosis. Asbestos bodies are distinguished from other ferruginous bodies by their thin, transparent core. Two or more asbestos bodies per square centimeter of a 5- mu m-thick lung section, in combination with interstitial fibrosis of the appropriate pattern, are indicative of asbestosis. Fewer asbestos bodies do not necessarily exclude a diagnosis of asbestosis, but evidence of excess asbestos would then require quantitative studies performed on lung digests. Quantification of asbestos load may be performed on lung digests or bronchoalveolar lavage material, employing either light microscopy, scanning electron microscopy, or transmission electron microscopy. Whichever technique is employed, the results are only dependable if the laboratory is well practiced in the method chosen, frequently performs such analyses, and the results are compared with those obtained by the same laboratory applying the same technique to a control population.

Contributions From the Pulmonary Pathology Society: Selected Topics on Nonneoplastic Diseases.

To the Editor.—The article “Transition From a Standard to a Hybrid On-Site and Remote Anatomic Pathology Training Model During the Coronavirus Disease 2019 (COVID-19) Pandemic,” published in the January 2021 issue of the Archives of Pathology & Laboratory Medicine, has done a commendable job in setting an example and providing a guideline that all institutions should ideally adopt at their pathology resident training programs during the present pandemic.1The boom in the use of telepathology has made information easily available. Trainees now have free access to a plethora of educational material on Twitter (Twitter, Inc), Facebook (Facebook, Inc), Whatsapp (Facebook, Inc), YouTube (Google LLC), etc. High-quality whole scanned digital images of a variety of common and rare cases are available on Web sites hosted by the College of American Pathologists, the International Society of Urological Pathology, and the Pulmonary Pathology Society, among others.2Unfortunately, adopting digital resources into routine pathology training is not as easy as it seems, especially in developing countries, where funds are limited. For example, real-time interactive microscopy sessions within a department require a high-speed Internet connection and consumption of large volumes of data per day. Because of these issues, in many institutions, the faculty have reverted to static images for teaching. As a result, trainees are deprived of a panoramic view of the slide.Moreover, most Webinars and video lectures are one-way sermons; they aren't always as effective in stimulating the residents' interest when compared to the pre–COVID-19 (pre–coronavirus disease 2019) conventional method of training, when residents had the privilege of working side-by-side with experienced faculty members while attending sign-outs and reviewing cases.Because the pandemic restrictions are ongoing, the “hybrid on-site and remote learning” set-up is here to stay for the time being. Technologically challenged trainers, as well as trainees, need to work to get ready to incorporate state-of-the-art technology into pathology training within their individual departments. For digital resources to be really effective, active participation by the residents as well as faculty should be ensured. For instance, there are many Facebook groups that were created for sharing interesting cases from across the world. These groups have thousands of members, however, most are passive, noncontributing members.3 So, for such online groups to generate a platform for robust brainstorming discussions, admission into the group should follow stricter rules. Every member should be required to make a contribution, at least once a month, in order to maintain membership. Real-time microscopy sessions and interactive video lecture sessions should be the main educational tools, along with regular polls and quizzes, Q&A (question and answer) sessions, and forums where trainees can post questions. And most importantly, periodic feedback questionnaires/surveys should be conducted, mainly for the residents, so that the standard of education and level of comfort is maintained and improved, and other technical difficulties (related to functioning of online platforms) are regularly addressed.It is high time for pathologists across the world to shed off inertia of 2020, come out of the doldrums, and enter 2021 with renewed zeal and medical knowledge.

BackgroundImmune checkpoint inhibitors (ICI) have become integral to non-small cell lung cancer (NSCLC) treatment. However, biomarkers predictive of immunotherapy efficacy are limited. Programmed Death Ligand 1 (PD-L1) expression has been...