Difference between revisions of "Pleural invasion"
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'''Pleural invasion''' is the presence of tumour in the [[pleura]]. Pleural invasion is poor prognosticator in [[lung cancer]],<ref name=pmid19057261>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Rami-Porta | first3 = R. | last4 = Vallières | first4 = E. | last5 = Tsuboi | first5 = M. | last6 = Rusch | first6 = V. | last7 = Goldstraw | first7 = P. | title = Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. | journal = J Thorac Oncol | volume = 3 | issue = 12 | pages = 1384-90 | month = Dec | year = 2008 | doi = 10.1097/JTO.0b013e31818e0d9f | PMID = 19057261 }}</ref><ref name=pmid15999057>{{Cite journal | last1 = Shimizu | first1 = K. | last2 = Yoshida | first2 = J. | last3 = Nagai | first3 = K. | last4 = Nishimura | first4 = M. | last5 = Ishii | first5 = G. | last6 = Morishita | first6 = Y. | last7 = Nishiwaki | first7 = Y. | title = Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. | journal = J Thorac Cardiovasc Surg | volume = 130 | issue = 1 | pages = 160-5 | month = Jul | year = 2005 | doi = 10.1016/j.jtcvs.2004.11.021 | PMID = 15999057 }}</ref> and important in determining the tumour stage in [[lung cancer staging]]. | '''Pleural invasion''' is the presence of tumour in the [[pleura]]. Pleural invasion is considered a poor prognosticator in [[lung cancer]],<ref name=pmid19057261>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Rami-Porta | first3 = R. | last4 = Vallières | first4 = E. | last5 = Tsuboi | first5 = M. | last6 = Rusch | first6 = V. | last7 = Goldstraw | first7 = P. | title = Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. | journal = J Thorac Oncol | volume = 3 | issue = 12 | pages = 1384-90 | month = Dec | year = 2008 | doi = 10.1097/JTO.0b013e31818e0d9f | PMID = 19057261 }}</ref><ref name=pmid15999057>{{Cite journal | last1 = Shimizu | first1 = K. | last2 = Yoshida | first2 = J. | last3 = Nagai | first3 = K. | last4 = Nishimura | first4 = M. | last5 = Ishii | first5 = G. | last6 = Morishita | first6 = Y. | last7 = Nishiwaki | first7 = Y. | title = Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. | journal = J Thorac Cardiovasc Surg | volume = 130 | issue = 1 | pages = 160-5 | month = Jul | year = 2005 | doi = 10.1016/j.jtcvs.2004.11.021 | PMID = 15999057 }}</ref> and important in determining the tumour stage in [[lung cancer staging]]. | ||
==General== | ==General== | ||
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Note: | Note: | ||
*The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.<ref name=pmid23020722/> | *The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.<ref name=pmid23020722/> | ||
*The up-staging of small tumours is not completely without controversy; there is data for lung adenocarcinomas less than 2 cm that suggests VPI is not an outcome predictor.<ref name=pmid23807749>{{Cite journal | last1 = Nitadori | first1 = J. | last2 = Colovos | first2 = C. | last3 = Kadota | first3 = K. | last4 = Sima | first4 = CS. | last5 = Sarkaria | first5 = IS. | last6 = Rizk | first6 = NP. | last7 = Rusch | first7 = VW. | last8 = Travis | first8 = WD. | last9 = Adusumilli | first9 = PS. | title = Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: a proposal to reclassify T1 lung adenocarcinoma. | journal = Chest | volume = 144 | issue = 5 | pages = 1622-31 | month = Nov | year = 2013 | doi = 10.1378/chest.13-0394 | PMID = 23807749 }}</ref> | |||
==Gross== | ==Gross== | ||
Revision as of 02:53, 23 October 2015
Pleural invasion is the presence of tumour in the pleura. Pleural invasion is considered a poor prognosticator in lung cancer,[1][2] and important in determining the tumour stage in lung cancer staging.
General
The visceral pleura is the pleura that covers the lung; tumour invasion into it is known as visceral pleural invasion (abbreviated VPI). The parietal pleural covers the chest wall.
The visceral pleura has two elastic layers:[3]
- External elastic layer.
- Usually thick/prominent.
- Important for staging.
- Internal elastic layer.
- Thin - may be difficult to see.
- Irrelevant for staging.
Modified Hammar classification
Pleural invasion can be subgrouped as follows:[1]
| Category | Description | Tumour stage (TNM staging) |
|---|---|---|
| PL0 | tumour confined to lung, not through elastic layer | T(any) |
| PL1 | tumour beyond (external) elastic layer of the visercal pleura, not at pleural surface | at least T2 |
| PL2 | tumour at surface of pleura, not in parietal pleura | at least T2 |
| PL3 | tumour within parietal pleura and visceral pleura | at least T3 |
Note:
- The interface between PL0 and PL1 is the most challenging. Use of an elastic stain is recommend when there is uncertainty.[3]
- The up-staging of small tumours is not completely without controversy; there is data for lung adenocarcinomas less than 2 cm that suggests VPI is not an outcome predictor.[4]
Gross
- Tumour close to visceral pleura, e.g. <1 mm - high probability of VPI.
- Puckering of the visceral pleura overlying the tumour - suspicious for VPI.
Microscopic
Features - for PL1:
- Must be through the external elastic layer.[3]
Note:
- Tumour trapped within the (external) elastic layer is still PL0.[3]
Stains
- Elastic stain (e.g. Miller, elastic trichrome, Verhoeff-van Gieson) - demonstrating tumour superficial to the (external) elastica.
See also
References
- ↑ 1.0 1.1 Travis, WD.; Brambilla, E.; Rami-Porta, R.; Vallières, E.; Tsuboi, M.; Rusch, V.; Goldstraw, P. (Dec 2008). "Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer.". J Thorac Oncol 3 (12): 1384-90. doi:10.1097/JTO.0b013e31818e0d9f. PMID 19057261.
- ↑ Shimizu, K.; Yoshida, J.; Nagai, K.; Nishimura, M.; Ishii, G.; Morishita, Y.; Nishiwaki, Y. (Jul 2005). "Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer.". J Thorac Cardiovasc Surg 130 (1): 160-5. doi:10.1016/j.jtcvs.2004.11.021. PMID 15999057.
- ↑ 3.0 3.1 3.2 3.3 Dacic, S. (Oct 2012). "Dilemmas in lung cancer staging.". Arch Pathol Lab Med 136 (10): 1194-7. doi:10.5858/arpa.2012-0282-CC. PMID 23020722.
- ↑ Nitadori, J.; Colovos, C.; Kadota, K.; Sima, CS.; Sarkaria, IS.; Rizk, NP.; Rusch, VW.; Travis, WD. et al. (Nov 2013). "Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma ≤ 2 cm: a proposal to reclassify T1 lung adenocarcinoma.". Chest 144 (5): 1622-31. doi:10.1378/chest.13-0394. PMID 23807749.