System : Thorax

Lung, Mediastinum


Thoracic Pathology is a comprehensive area including all organs within the thoracic cavity such as lungs, pleura, thymus, and heart.

The sign-out activity and referrals includes biopsy, cytology and resection specimens of thoracic neoplasms or performed for inflammatory lung disease diagnosis.

Among all the thoracic pathology cases, the vast majority are for the diagnosis of lung cancer, which remains the first cause of cancer death world-wild. However, its poor prognosis has been improved for the last years by the discovery of targetable genomic abnormalities and by the development of immunotherapies with related predictive biomarkers. Thoracic pathology is based on morphology and most often immunohistochemistry, with additional molecular analyses (mutational status, FISH, RNAseq, etc) required for targeted therapies.

Why refer cases for a second opinion ?

The new WHO 2015 classification of thoracic malignancies, including lung, mediastinum and pleura tumors, has provided new recommendations for small samples with specific diagnostic algorithm integrating immunohistochemistry and molecular profiling.

However, some grey zones persist, particularly for adenocarcinoma and neuroendocrine carcinoma subtypes, invasion process and interpretation of immunohistochemical markers.
In addition, some new entities have been described recently, such as SMARCA4 deficient thoracic tumors, and pathologists have to perform in the era of precision medicine new biomarkers all available at the Biopathology department of Léon Bérard Cancer Institute to enable patients to be eligible for targeted therapies and immunotherapies.