The morphological and molecular diagnosis of lung cancer.

BACKGROUND: In Germany, lung cancer causes more deaths than any other malignant disease. Its main etiology is smoking, but other risk factors need to be considered as well. The morphological, molecular and biological phenotype is complex and should no longer be just categorized as either small-cell or non-small cell lung cancer.

METHODS: This review article is based on the authors' longstanding involvement in the scientific investigation and diagnostic evaluation of lung cancer, including contributions to the current WHO classification and collaboration in the new interdisciplinary classification of adenocarcinoma. The relevant literature was selectively reviewed.

RESULTS: Lung cancer is morphologically classified into four main subtypes-small-cell carcinoma, squamous-cell carcinoma, adenocarcinoma, and large-cell carcinoma. Genetic and molecular analyses have revealed distinct differences within subtypes; in particular, adenocarcinomas can be further subdivided. Complex techniques of genomic analysis are now available, but clinicopathological data are still the most important determinants of prognosis and are clearly better for this purpose than molecular classification alone. Nonetheless, the assessment of specific molecular markers is becoming increasingly important.

CONCLUSION: The morphological and molecular classification of lung cancer is undergoing a re-evaluation which will lead to more accurate assessment of individual prognoses and to improved prediction of the response to specific treatment regimens.