Visceral pleural invasion

Last revised by Dr Daniel J Bell on 30 Nov 2021

Visceral pleural invasion is a feature that can be seen in lung cancers. It is defined as tumor extension beyond the elastic layer of the visceral pleura, and in some cases may result in a cancer crossing a fissure to invade an adjacent lobe of the lung. It is considered an aggressive sign and one of the most important adverse prognostic factors in non-small cell lung cancers 1.

There are three described levels of invasion (based on histology):

  • PL0: represents tumor invading either the subpleural lung parenchyma or superficially the pleural connective tissue beneath the elastic layer
  • PL1: refers to a tumor that invades beyond the elastic layer without being exposed on the pleural surface
  • PL2: refers to a tumor that is exposed on the pleural surface, but it does not involve adjacent anatomic structures

The presence of type 2 pleural tags has been shown to have a moderate association with visceral pleural invasion 7.

According to one study, there was ~20% (range 10-30%) worse 5-year survival in tumors with visceral pleural invasion compared to those without visceral pleural invasion.

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