Akciğer Adenokarsinomlarında Dünya Sağlık Örgütü Sınıflaması, Histopatolojik Derece ve Patern Analizi

Öz

Akciğer tümörlerinin histopatolojik olarak sınıflamak için “Dünya Sağlık Örgütü (DSÖ)-2021 Torasik Tümörler Sınıflaması” kullanılmaktadır. Son dekatda, akciğer tümörlerinin moleküler temelleri ve tedavisindeki gelişmeler sonucunda, bir önceki DSÖ-2015 sınıflaması, adenokarsinomlarda önemli yenilikler getirmiştir. Son sınıflama olan DSÖ- 2021’ de ise, az sayıda yeni tanımlanan antite ve minör değişiklikler dışında, 2015 sınıflaması ana hatlarını korumuştur. DSÖ-2021 sınıflamasında, yenilik olarak, invaziv adenokarsinom, non-müsinöz ve müsinöz tip olarak iki ana kategoride sınıflanmış, ek olarak nadir varyantlar belirtilmiştir. DSÖ-2015 sınıflamasında, non-müsinöz adenokarsinomlarda, baskın paterni alt tip olarak belirterek prognoz ile iyi bir korelasyon gösterilmiş ancak resmi bir derecelendirme sistemi geliştirilmemiştir. Son DSÖ sınıflamasında, adenokarsinomlarda baskın patern ile alt tip sınıflaması yerini korumuş ve prognoz ile ilişkili, üç kademeli yeni bir derecelendirme sistemi geliştirilmiştir. Bu derleme yazısında, adenokarsinomlarda son DSÖ sınıflamasında yapılan değişiklikler, yeni derecelendirme sistemi ve bu tümörlerin prekürsör lezyonlardan histopatolojik ayırımında, alt tip tayininde ve derecelendirmede kullandığımız paternler analiz edilmiştir.

Anahtar Kelimeler

• Akciğer adenokarsinomu
• DSÖ sınıflaması
• derecelendirme
• patern analizi

World Health Organization Classification, Histopathological Grade and Pattern Analysis of Lung Adenocarcinoma

Abstract

"World Health Organization (WHO)-2021 Classification of Thoracic Tumors" is used to classify lung tumors histopathologically. In the last decade, as a result of the developments in the molecular basis and treatment of lung tumors, the previous WHO-2015 classification brought important innovations in adenocarcinomas. In the last classification, WHO-2021, the 2015 classification has preserved its main lines, except for a few newly defined entities and minor changes. In the WHO-2021 classification, as novelty, invasive adenocarcinoma was classified into two main categories as non-mucinous and mucinous types, additionally rare variants were specified. The WHO-2015 classification showed a good correlation with prognosis in non-mucinous adenocarcinomas, specifying the predominant pattern as a subtype, but a formal grading system has not been developed. In the latest WHO classification, subtype classification with the dominant pattern has remained and a new three-tiered grading system has been developed, which is related to prognosis. In this review article, the changes made in the latest WHO classification of adenocarcinomas, the new grading system and the basic patterns we used in the histopathological differentiation of these tumors from precursor lesions, subtype determination and grading are analyzed.

Keywords

• Akciğer adenokarsinomu
• DSÖ sınıflaması
• derecelendirme
• patern analizi

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