Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice

J.L. Derks*, N. Rijnsburger, B.C.M. Hermans, L. Moonen, L.M. Hillen, J.H. von der Thusen, M.A. den Bakker, R.J. van Suylen, E.J.M. Speel, A.M.C. Dingemans

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

7 Citations (Web of Science)

Abstract

Diagnosing a pulmonary neuroendocrine neoplasm (NEN) may be difficult, challenging clinical decision making. In this review, the following key clinical and pathologic issues and informative molecular markers are being discussed: (1) What is the preferred outcome parameter for curatively resected low-grade NENs (carcinoid), for example, overall survival or recurrence-free interval? (2) Does the WHO classification combined with a Ki-67 proliferation index and molecular markers, such as OTP and CD44, offer improved prognostication in low-grade NENs? (3) What is the value of a typical versus atypical carcinoid diagnosis on a biopsy specimen in local and metastatic disease? Diagnosis is difficult in biopsy specimens and recent observations of an increased mitotic rate in metastatic carcinoid from typical to atypical and high-grade NEN can further complicate diagnosis. (4) What is the (ir)relevance of morphologically separating large cell neuroendocrine carcinoma (LCNEC) SCLC and the value of molecular markers (RB1 gene and pRb protein or transcription factors NEUROD1, ASCL1, POU2F3, or YAP1 [NAPY]) to predict systemic treatment outcome? (5) Are additional diagnostic criteria required to accurately separate LCNEC from NSCLC in biopsy specimens? Neuroendocrine morphology can be absent owing to limited sample size leading to missed LCNEC diagnoses. Evaluation of genomic studies on LCNEC and marker studies have identified that a combination of napsin A and neuroendocrine markers could be helpful. Hence, to improve clinical practice, we should consider to adjust our NEN classification incorporating prognostic and predictive markers applicable on biopsy specimens to inform a treatment outcome-driven classification. (C) 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc.
Original languageEnglish
Pages (from-to)1632-1646
Number of pages15
JournalResearch in Social & Administrative Pharmacy
Volume16
Issue number10
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • Pulmonary NENs
  • NET
  • Neuroendocrine carcinoma
  • Diagnosis
  • Molecular markers
  • CELL LUNG-CANCER
  • HIGH PROLIFERATIVE ACTIVITY
  • SOCIETY EXPERT CONSENSUS
  • MULTICENTER-PHASE-II
  • CARCINOID-TUMORS
  • PROGNOSTIC-SIGNIFICANCE
  • MOLECULAR SUBTYPES
  • PD-L1 EXPRESSION
  • SCLC
  • DIAGNOSIS

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