Pathology Committee - International Association for the Study of Lung Cancer

IASLC Pathology Committee

Mission Statement:

To advance clinical management, education and research for the IASLC, in relation to the pathology of thoracic cancers, the functions of the IASLC Pathology Committee include:

Developing new ideas on improving the pathological classification of thoracic malignancies.
Conducting studies and developing criteria that lead to greater accuracy of tumor diagnosis by pathologists worldwide.
Developing standards and reference materials for molecular testing that are becoming necessary for personalizing patient treatment with new targeted therapies in lung cancer.

IASLC Pathology Committee 2018

Current Projects:

Reproducibility study invasion and micro-staging on small size adenocarcinoma (E. Thunnissen, M. Noguchi): The current WHO classification of adenocarcinoma has strength, but also some weaknesses. Determination of invasion has lead to variation of interpretation in daily practice. Not surprisingly the measurement of invasion leads also to a large variation. This may partly be explained by the two dimensional terminology of the adenocarcinoma classification. This project aims at modifying the current classification in order to obtain a better world wide application standard.

Drs. Thunnissen and Noguchi will continue leading this project and create a Working Group to perform a deeper study based on the preliminary data presented.

Adenocarcinoma grading project (A. Moreira): The purpose of this project is to create an objective system for adenocarcinoma, based on histological features. The IASLC classification of adenocarcinoma is based on the predominant pattern of growth that has been shown to be associated with prognosis. However, many other histological features of the tumors have also been suggested to be of prognostic value (secondary patterns of growth, nuclear grade, mitotic counts, STAS, etc.) For this project, all proposed prognostic features will be evaluated in a multicentric database contributed by members of the Pathology Panel. The parameters and/or combinations that are relavant to prognostication will serve as the basis for the grading system. The grading scheme will be tested and validated in additional datasets.

The original group working on this project includes Yuko Minami, Mari Mino-Kenudson, Andrew Nicholson and Giuseppe Pelosi and Andre Moreira. There are about 500 cases with outcomes collected and evaluated for grading. Statistical results are pending. Dr. Moreira will lead a cytology Working Group to promote grading and other studies in cytology samples.

Diagnostic IHC recommendations (Y. Yatabe): Immunohistochemistry (IHC) is routinely used in diagnosing lung cancer, particularly with small biopsy/cytology specimens and poorly-differentiated tumors. Currently, TTF1 and p40 staining efficiently separates adenocarcinoma and squamous cell carcinoma, respectively, even in the case of poorly-differentiated NSCLC with small biopsies and cytologic specimens. However, there are disadvantages to selecting an antibody panel, antibody clones, and interpreting the staining. The purpose of this project is to address these challenges to benefit the practicing community.

To provide some answers in response to these difficult situations, the Pathology Committee drafted a consensus report on IHC. They plan to submit a final draft to JTO in August 2018. Once the report is published, the committee plans to create an atlas, diagnostic workflow recommendation cards and webinars.

Staging Committee (A. Nicholson): Dr. Nicholson will follow up with Dr. Borczuk to coordinate future activities regarding the R factor Working Group. The chair and some committee members are discussing the possibility of starting a project on applying molecular assays for better determination of primary vs. metastasis (in cases of multiple tumors in lung cancer).

Major Pathological Response to Neo-adjuvant Therapies (W. Travis and I. Wistuba) The purpose of this project is to a) establish recommendations for pathological processing and analysis of neoadjuvant-treated lung cancer specimens (both primary tumors and lymph node metastasis); b) standardized assessment of pathological response in primary tumors and lymph node metastasis on both IMT and chemotherapy in the context of clinical trials and standard of care practice; c) perform inter-observer studies; and, d) apply image analysis approaches for response assessment. There is consideration to also include in this study immune cell infiltration analysis in lung cancer tissue specimens.

DLL3 IHC (F. Hirsch): This project aim is to standardize and validate DLL3 IHC in SCLC in collaboration with AbbVie and Ventana. Drs. Hirsch and Kerr will lead the working group discussion.