Pathologic diagnosis of lung adenocarcinoma
Keywords:
Lung adenocarcinoma; cytology; immunohistochemistry; clinical pathologyAbstract
Introduction: Lung cancer is a major global health problem, with adenocarcinoma being the most frequent histological subtype.
Objective: To review recent advances on the pathological diagnosis of lung adenocarcinoma and the importance of its classification.
Methods: A structured narrative review was conducted using PubMed, Scopus, SciELO and Web of Science (2015-2025). Original articles, systematic reviews, and international consensus on histopathology, immunohistochemistry, and biomarkers were selected.
Results: The grading system for invasive non-mucinous adenocarcinoma was analyzed, identifying a ≥ 20 % presence of solid or micropapillary patterns as high-grade. Spread Through Air Spaces (STAS) in surgical specimens is recognized as a pattern of invasion associated with a poor prognosis. Furthermore, the management of small specimens (biopsy and cytology) is emphasized through the use of minimal immunohistochemistry panels (TTF-1/p40) to preserve tissue for molecular studies (EGFR, ALK, ROS1) and PD-L1 testing.
Conclusions: The integration of updated histological grading criteria, the rational use of immunohistochemistry, and molecular profiling allow for an accurate diagnosis that guides targeted therapy selection, even in small-volume samples.
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