Adenocarcinoma in situ of the lung
Citation, DOI & article data
Adenocarcinomas in situ (AIS) of the lung refer to a relatively new entity with falls under the spectrum of pre-invasive lesions of the lungs. This entity partly replaces the noninvasive end of the previous term bronchoalveolar carcinoma. Adenocarcinoma in situ is defined as a localized adenocarcinoma of <3 cm that exhibits a lepidic growth pattern, with neoplastic cells along the alveolar structures but without stromal, vascular, or pleural invasion 1.
AISs are localized adenocarcinomas of ≤3 cm, with no growth pattern other than lepidic, with neoplastic cells along the alveolar structures but without stromal, vascular, lymphatic, or pleural invasion, and no features of necrosis 6.
There are three histopathological subtypes, the most common is non-mucinous, with mucinous or mixed subtypes being rarely found.
While adenocarcinoma in situ is usually seen as a pure ground-glass nodule or a part-solid lung nodule, there can be overlap among the imaging features of atypical adenomatous hyperplasia, adenocarcinoma in situ, and invasive adenocarcinoma of the lung 1.
Adenocarcinomas in situ are commonly associated with PET false-negative results. FDG PET-CT is recommended when assessing subsolid ground-glass lung lesions that have a solid component measuring more than 8 mm 5.
Treatment and prognosis
Adenocarcinoma in situ carries an excellent prognosis, with reported survival rates of 100% following complete tumor resection 6.
For follow-up guidelines consider - Fleischner Society pulmonary nodule recommendations
- 1. Lee SM, Goo JM, Park CM et-al. A new classification of adenocarcinoma: what the radiologists need to know. Diagn Interv Radiol. 2012;18 (6): 519-26. doi:10.4261/1305-3825.DIR.5778-12.1 - Pubmed citation
- 2. Kerr KM. Pulmonary adenocarcinomas: classification and reporting. Histopathology. 2009;54 (1): 12-27. Histopathology (full text) - doi:10.1111/j.1365-2559.2008.03176.x - Pubmed citation
- 3. Yatabe Y, Borczuk AC, Powell CA. Do all lung adenocarcinomas follow a stepwise progression?. Lung Cancer. 2011;74 (1): 7-11. doi:10.1016/j.lungcan.2011.05.021 - Free text at pubmed - Pubmed citation
- 4. Lee HJ, Lee CH, Jeong YJ et-al. IASLC/ATS/ERS International Multidisciplinary Classification of Lung Adenocarcinoma: novel concepts and radiologic implications. J Thorac Imaging. 2012;27 (6): 340-53. doi:10.1097/RTI.0b013e3182688d62 - Pubmed citation
- 5. Kandathil A, Kay FU, Butt YM, Wachsmann JW, Subramaniam RM. Role of FDG PET/CT in the Eighth Edition of TNM Staging of Non-Small Cell Lung Cancer. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 2134-2149. doi:10.1148/rg.2018180060 - Pubmed
- 6. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. (2011) Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 6 (2): 244-85. doi:10.1097/JTO.0b013e318206a221 - Pubmed
- 7. Lambe G, Durand M, Buckley A, Nicholson S, McDermott R. Adenocarcinoma of the lung: from BAC to the future. (2020) Insights into imaging. 11 (1): 69. doi:10.1186/s13244-020-00875-6 - Pubmed