Abstract
BackgroundSynchronous multifocal lung cancer (SMLC) is diagnosed with increasing frequency in clinical practice globally. Due to innate variation in clinical management and outcome, it is vital to properly distinguish between synchronous multifocal primary lung cancer (SMPLC) and intrapulmonary metastasis (IM). The pathologic features and principal classification criteria of multifocal lung cancer remain unclear. Our objective was to evaluate the diagnostic value of histological morphologic features and driver gene mutations in SMLC classification.MethodsWe collected a unique cohort of Chinese patients with SMLC, and fully explored the morphologic, immunohistochemical, and molecular features of the disease. Twenty-one SMLC patients with a total of 50 tumours were included in our study. The pathological features that were presented by these patients were analysed, including the tumours location, tumours size, pathological types, predominant pattern of adenocarcinoma, and immunohistochemical staining. We conducted molecular testing of nine driver oncogenes that are associated with lung cancer, namely, EGER, KRAS, BRAF, NRAS, ALK, ROS1, RET, HER2, and PIK3CA.ResultsAccording to the Martini-Melamed classification and refined standard, 8 and 17 patients, respectively, were considered to have SMPLCs. Gene mutations were identified in 18 tumours (36%). Twelve patients had different gene mutations.ConclusionsWe demonstrate that conventional morphological assessment is not sufficient to clearly establish the clonal relationship of SMPLCs. Instead, the evaluation of histological subtypes, including nonmucinous adherent components, is required. Multiplex genotypic analysis may also prove to be a useful additional tool.
Highlights
Synchronous multifocal lung cancer (SMLC) is diagnosed with increasing frequency in clinical practice globally
With the increased use of high-resolution computed tomography (CT) in lung cancer screening, there has been a substantial rise in the apparent incidence of pulmonary nodules, synchronous multifocal lung cancers (SMLCs) [1, 2]
Full list of author information is available at the end of the article one pulmonary nodule raises a critical clinical question: Do such nodules arise from the same clone or do they represent multiple lung cancers with independent lineages? The accurate distinction between synchronous multifocal primary lung cancers (SMPLCs) and intrapulmonary metastasis (IM) is vital since it guides therapeutic management
Summary
Synchronous multifocal lung cancer (SMLC) is diagnosed with increasing frequency in clinical practice globally. Due to innate variation in clinical management and outcome, it is vital to properly distinguish between synchronous multifocal primary lung cancer (SMPLC) and intrapulmonary metastasis (IM). The pathologic features and principal classification criteria of multifocal lung cancer remain unclear. The accurate distinction between synchronous multifocal primary lung cancers (SMPLCs) and intrapulmonary metastasis (IM) is vital since it guides therapeutic management. It remains challenging [3]. (2021) 21:176 researchers mainly considered clinical and pathological characteristics, such as histological classification, tumours location, presence/absence of adenocarcinoma in situ (AIS), and lymph node metastases. The morphologies of the primary and metastatic foci should be consistent, without considering the histological subtypes or molecular features of the tumour
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