The World Health Organization Reporting System for Lung Cytopathology

Fernando C Schmitt; Lukas Bubendorf; Sule Canberk; Ashish Chandra; Ian A Cree; Marianne Engels; Kenzo Hiroshima; Deepali Jain; Ivana Kholová; Lester Layfield; Ravi Mehrotra; Claire W Michael; Robert Osamura; Martha B Pitman; Sinchita Roy-Chowdhuri; Yukitoshi Satoh; Paul VanderLaan; Maureen F Zakowski; Andrew S Field

doi:10.1159/000527580

The World Health Organization Reporting System for Lung Cytopathology

Acta Cytol. 2023;67(1):80-91. doi: 10.1159/000527580. Epub 2022 Dec 12.

Authors

Fernando C Schmitt^{1

2

3}, Lukas Bubendorf⁴, Sule Canberk^{3

5

6}, Ashish Chandra⁷, Ian A Cree⁸, Marianne Engels⁹, Kenzo Hiroshima¹⁰, Deepali Jain¹¹, Ivana Kholová¹², Lester Layfield¹³, Ravi Mehrotra¹⁴, Claire W Michael¹⁵, Robert Osamura¹⁶, Martha B Pitman¹⁷, Sinchita Roy-Chowdhuri¹⁸, Yukitoshi Satoh¹⁹, Paul VanderLaan²⁰, Maureen F Zakowski²¹, Andrew S Field²²

Affiliations

¹ Department of Pathology, Faculty of Medicine of University of Porto, Porto, Portugal.
² CINTESIS@RISE, Health Research Network, Porto, Portugal.
³ IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.
⁴ Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.
⁵ Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.
⁶ Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal.
⁷ Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
⁸ International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France.
⁹ Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁰ Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan.
¹¹ Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
¹² Department of Pathology, Fimlab Laboratories and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
¹³ Pathology and Anatomic Science Department, University of Missouri, Columbia, Missouri, USA.
¹⁴ Indian Cancer Genomic Atlas, Centre for Health, Innovation and Policy Foundation, Noida, India.
¹⁵ Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA.
¹⁶ Department of Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki, Japan.
¹⁷ Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ Department of Pathology, Molecular Diagnostics Laboratory, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁹ Department of Thoracic Surgery, Kitasato University School of Medicine, Tokyo, Japan.
²⁰ Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
²¹ Mount Sinai Medical Center, New York, New York, USA.
²² Department of Anatomical Pathology, St Vincent's Hospital, Sydney, and University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia.

PMID: 36509066
DOI: 10.1159/000527580

Abstract

The International Academy of Cytology has joined with the International Agency for Research on Cancer (IARC) to bring together a group of experts in lung cytopathology to develop a WHO Reporting System for Lung Cytopathology (WHO System). This WHO System defines five categories for reporting lung cytopathology, that is, "Insufficient"/"Inadequate"/"Non-diagnostic," "Benign," "Atypical," "Suspicious for malignancy," and "Malignant," each with a clear descriptive term for the category, a definition, a risk of malignancy and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category have been established by consensus and will be presented more fully in a subsequent IARC e-book and published hard cover book.The WHO System provides the best practice application of ancillary testing, including immunocytochemistry and molecular pathology, and provides a review to guide sampling and processing techniques to optimize the handling and preparation of the cytopathology sample emphasizing the cytomorphological differential diagnosis to aid low-resourced settings. The authors recognize that local medical and pathology resources will vary, particularly in low- and middle-income countries, and have developed the WHO System to make it applicable worldwide based on cytomorphology with options for further diagnostic management of the patient.The online WHO System provides a direct link to the WHO Tumour Classification for Thoracic Tumours 5th Edition. It will raise the profile and use of cytopathology by increasing awareness of its current role and its potential role in the era of personalized medicine based on molecular pathology utilizing "small biopsies." Ultimately, the System will improve patient care and outcomes.This System aims to improve and standardize the reporting of cytopathology, facilitate communication between cytopathologists and clinicians and improve patient care. The System is based on the current role of lung cytopathology and synthesizes the existing evidence while highlighting areas requiring further research and the future potential role of lung cytopathology.

Keywords: Fine needle aspirate biopsies; International Academy of Cytology; Lung cytology; WHO Reporting Systems for cytopathology.

Publication types

Review

MeSH terms

Biopsy, Fine-Needle
Cytodiagnosis
Humans
Lung
Pathology, Clinical*

Grants and funding

001/WHO_/World Health Organization/International