Our Summary

The International Academy of Cytology and the International Agency for Research on Cancer have teamed up to establish a standardized reporting system for lung cytopathology, which is the study of diseases at the cellular level in the lungs. The World Health Organization (WHO) System categorizes the results into five groups, ranging from “insufficient” samples to “malignant” or cancerous cells. Each category has a clear definition, a gauge for cancer risk, and a suggested plan of action.

The system also provides guidelines on best practices for additional testing and how to properly collect and prepare samples, with an emphasis on helping areas with limited resources. The authors acknowledge that the availability of resources may differ across regions and countries, especially in low- to middle-income areas. The system will be accessible online and will be linked to the WHO’s Tumor Classification for Thoracic Tumors 5th Edition.

The overall aim is to improve and standardize how we report cytopathology, improve communication between pathologists and clinicians, and ultimately, enhance patient care. This system is particularly relevant in the era of personalized medicine, where treatments can be tailored based on a patient’s genetic makeup.

FAQs

  1. What is the purpose of the standardized reporting system for lung cytopathology established by the International Academy of Cytology and the International Agency for Research on Cancer?
  2. How does the World Health Organization (WHO) System categorize the results of lung cytopathology?
  3. How does this standardized system improve patient care and communication between pathologists and clinicians?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung biopsy is to make sure to follow any pre-procedure instructions provided by the healthcare team, such as fasting before the procedure or adjusting medications. It is important to communicate any allergies or medical conditions to the healthcare team before the biopsy. After the procedure, it is important to follow any post-procedure instructions, such as avoiding strenuous activities or taking prescribed medications as directed. It is also important to keep all follow-up appointments with the healthcare team to discuss the results of the biopsy and any further treatment options.

Suitable For

Patients who are typically recommended for a lung biopsy include those with:

  1. Suspicious pulmonary nodules or masses detected on imaging studies such as chest X-rays or CT scans.
  2. Symptoms such as persistent cough, shortness of breath, chest pain, or coughing up blood that cannot be explained by other tests.
  3. Known or suspected lung cancer, including those with a history of smoking or exposure to carcinogens.
  4. Monitoring or follow-up of known lung conditions such as interstitial lung disease, pulmonary fibrosis, or sarcoidosis.
  5. Evaluation of lung infections such as tuberculosis or fungal infections that are not responding to standard treatments.
  6. Assessment of lung diseases that are difficult to diagnose based on clinical symptoms and imaging studies alone, such as certain types of lung cancer or rare lung diseases.
  7. Evaluation of abnormal findings on bronchoscopy or other diagnostic tests that require further investigation.
  8. Assessment of the extent or stage of lung cancer to determine the appropriate treatment plan.
  9. Monitoring of treatment response in patients with lung cancer or other lung diseases to guide further management decisions.
  10. Research purposes to study the cellular changes in the lungs and develop new diagnostic or treatment approaches.

It is important for patients to discuss the risks and benefits of a lung biopsy with their healthcare provider, as well as any alternative diagnostic options that may be available. The decision to undergo a lung biopsy should be based on individual factors such as the patient’s overall health, the suspected diagnosis, and the potential impact on treatment decisions.

Timeline

Before lung biopsy:

  1. Patient presents with symptoms such as coughing, chest pain, or difficulty breathing.
  2. Medical history and physical examination are conducted by a healthcare provider.
  3. Imaging tests such as chest X-ray or CT scan may be performed to identify abnormalities in the lungs.
  4. Blood tests may be ordered to check for markers of disease or infection.
  5. Decision is made to perform a lung biopsy to obtain a tissue sample for further evaluation.

After lung biopsy:

  1. Patient undergoes the biopsy procedure, which can be done through different methods such as bronchoscopy, needle biopsy, or surgical biopsy.
  2. Tissue sample is sent to the laboratory for analysis by a pathologist.
  3. Pathologist examines the sample under a microscope to determine if there are any abnormal cells present.
  4. Results are reported using the standardized WHO System, categorizing the findings into different risk groups.
  5. Based on the results, a treatment plan is developed which may include further testing, monitoring, or treatment for any identified conditions.
  6. Patient follows up with their healthcare provider to discuss the results and next steps in their care.

What to Ask Your Doctor

  1. What is the purpose of the lung biopsy?
  2. What type of lung biopsy will be performed (e.g. bronchoscopy, needle biopsy, surgical biopsy)?
  3. What are the potential risks and complications associated with the procedure?
  4. How will the biopsy results be communicated to me?
  5. How soon can I expect to receive the results?
  6. What will the biopsy results tell us about my condition?
  7. What are the possible treatment options based on the biopsy results?
  8. Will I need any additional tests or procedures based on the biopsy results?
  9. How will the biopsy results impact my overall treatment plan?
  10. Are there any lifestyle changes I should consider based on the biopsy results?

Reference

Authors: Schmitt FC, Bubendorf L, Canberk S, Chandra A, Cree IA, Engels M, Hiroshima K, Jain D, Kholová I, Layfield L, Mehrotra R, Michael CW, Osamura R, Pitman MB, Roy-Chowdhuri S, Satoh Y, VanderLaan P, Zakowski MF, Field AS. Journal: Acta Cytol. 2023;67(1):80-91. doi: 10.1159/000527580. Epub 2022 Dec 12. PMID: 36509066