Purpose: The distinction between multiple primary lung cancers (MPLCs) and intrapulmonary metastases has a significant impact on tumor staging and therapeutic choices. Several criteria have been proposed to solve this diagnostic issue, but a definitive consensus is still missing. We tested the efficacy of a combined clinical, histopathological and molecular ("real world") approach for the correct classification of multiple lung tumors in a selected cohort of patients.
Methods: 24 multiple lung tumors with a diagnosis of adenocarcinoma from 10 patients were retrospectively reviewed. Radiological, pathological and clinical information, including follow-up, were integrated with molecular profiling via a routine multigene panel sequencing.
Results: Comprehensive histologic assessment revealed readily distinguishable histologic patterns between multiple tumors suggesting unrelated lesions in 7 cases, in agreement with clinical, radiological and molecular data, thus leading to final diagnosis of MPLCs. In the remaining 3 cases, the differential diagnosis between MPLCs and intrapulmonary metastases was challenging, since the histologic features of the lesions were similar or identical. The final interpretation (2 MPLCs and 1 most likely intrapulmonary metastases) was reached thanks to the integration of all available data, and was confirmed by follow-up.
Conclusions: A multidisciplinary approach including a routinely affordable multigene panel sequencing is a useful tool to discriminate MPLCs from intrapulmonary metastases in multiple lung nodules sharing the adenocarcinoma histotype.
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| http://dx.doi.org/10.1016/j.prp.2021.153387 | DOI Listing |
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Article Synopsis
- - Multiple primary lung cancer (MPLC) is becoming more common and is classified into synchronous (sMPLC) and metachronous (mMPLC) types, which require careful differentiation from intrapulmonary metastases (IPM) for proper treatment.
- - Diagnosis of MPLC relies on histology, imaging, and molecular methods, with imaging being crucial for preoperative assessments and histology providing definitive diagnoses.
- - Surgical intervention is the primary treatment option, supplemented by techniques like stereotactic radiotherapy and ablation for lesions that can't be surgically removed; targeted therapies and immunotherapies may also be used, highlighting the importance of a multidisciplinary approach in treatment planning.
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