Radiological Aspects of the New “International Multidisciplinary Classification of Lung Adenocarcinoma”: Methodological Bases and Own Experience

Abstract

Purpose – to improve the efficiency of diagnosis and treatment of patients with pulmonary adenocarcinoma by introducing in Ukraine a new “International Multidisciplinary Classification ...” adopted by WHO in 2015. For radiologists, this classification recommends CT semiotics of pulmonary adenocarcinoma according to its histological subtypes. Distinguish: preinvasive (atypical adenomatous hyperplasia – AAG, adenocarcinoma in situ – AIS), minimally invasive (minimally invasive adenocarcinoma – MIA) and invasive (predominantly lepidic adenocarcinoma – LPA, invasive mucinous adenocarcinoma – IMA) lesions. In accordance with the recommendations of the International Association for the study of lung cancer, the American thoracic society and the European respiratory society: ground glass nodule (GGN) or partially solid formations with predominance of the GGN component in CT images should be interpreted using new Terms: AIS, MIA and LPA. On sufficiently thin (≤ 3 mm) CT sections, when evaluating partially solid composites, the size of the solid component and the total size, including GGN, should be separately measured. With limited resources of the country (region, institution) in conducting molecular and immunohistochemical studies, the authors of the "International Multidisciplinary Classification ..." recommend determining the stage of adenocarcinoma by all available methods and starting treatment of patients (surgical, chemotherapy) based on TNM factors. Conclusion. The implementation status of the new (WHO, 2015) “International Multidisciplinary Classification of Lung Adenocarcinoma” in Ukraine should be considered unsatisfactory. At the same time, on the basis of CT data, the radiologist has the opportunity to suggest the presence of one of its five histological subtypes and recommend to the clinician the next steps in making a diagnosis (specific additional examination, consultations of other specialists, the timing of the CT scan, etc.). Based on this information, the morphologist more accurately determines the histological type of the tumor, and the oncologist chooses the most effective way to treat the patient. Key words: multidisciplinary classification, pulmonary adenocarcinoma, computed tomography.