Clinical implications of lung neuroendocrine neoplasm classification

Expert Rev Anticancer Ther. 2021 Apr;21(4):377-387. doi: 10.1080/14737140.2021.1862654. Epub 2020 Dec 24.


Introduction: Neuroendocrine neoplasms of the lung (Lung NENs) encompass NE tumors (NETs), which are in turn split into typical and atypical carcinoids, and NE carcinomas (NECs), which group together small-cell carcinoma and large-cell NE carcinoma. This classification is the current basis for orienting the daily practice of these patients, with diagnostic, prognostic, and predictive inferences.

Areas covered: The clinical implications of lung NEN classification are addressed according to three converging perspectives, which were dissected through an extensive literature overview: (1) how to put intratumor heterogeneity into the context of the current classification; (2) how to contextualize immunohistochemistry markers to improve diagnosis, prognosis, and therapy prediction; and (3) how to use immuno-oncology strategies for life-threatening NECs, which still account for 90% or more of lung NENs.

Expert opinion: We provide practical insights to account for intratumor heterogeneity, practice the choice of immunohistochemistry markers, and emphasize once again the added value of immuno-oncology in the setting of personalized medicine of lung NENs.

Keywords: Neuroendocrine; carcinoma; diagnosis; immuno-oncology; immunohistochemistry; intratumor heterogeneity; lung; marker; personalized medicine; precision medicine; prediction; prognosis; tumor.

Publication types

  • Review

MeSH terms

  • Animals
  • Carcinoid Tumor / classification
  • Carcinoid Tumor / pathology
  • Carcinoid Tumor / therapy
  • Carcinoma, Neuroendocrine / classification*
  • Carcinoma, Neuroendocrine / pathology
  • Carcinoma, Neuroendocrine / therapy
  • Carcinoma, Small Cell / classification
  • Carcinoma, Small Cell / pathology
  • Carcinoma, Small Cell / therapy
  • Humans
  • Immunohistochemistry
  • Lung Neoplasms / classification*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Neuroendocrine Tumors / classification*
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / therapy
  • Precision Medicine
  • Prognosis