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Publications

Journal Article Review Ahead of print

PubMed: 42251892 DOI: 10.1016/j.jtho.2026.103977

IASLC Update on Classification of Pulmonary Neuroendocrine Neoplasms.

J Thorac Oncol

Authors: Mary Beth Beasley, Yasushi Yatabe, Mauro Papotti, Wendy A Cooper, Jules L Derks, Lynnette Fernandez-Cuesta, Atsuko Kasajima, Sylvie Lantuejoul, Giuseppe Pelosi, Natasha Rekhtman, Anja C Roden, Ernst Jan M Speel, William D Travis

Affiliations

  • Department of Pathology, Ichan School of Medicine at Mount Sinai, New York, NY.
  • Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
  • Department of Pathology, University of Turin, Italy.
  • Royal Prince Alfred Hospital, NSW Health Pathology, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, NSW, Australia.
  • Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
  • Computational Cancer Genomics Team, Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
  • Department of Pathology, TUM School of Medicine and Health, Munich, Germany.
  • Grenoble Alpes University and Department of Biopathology, CLCC UNICANCER Léon Bérard, Lyon, France.
  • Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
  • Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
  • Department of Pathology and Clinical Bioinformatics, Erasmus Medical Centre, Rotterdam, The Netherlands.

Abstract

Since the publication of the 2021 WHO classification of thoracic tumors, our knowledge of pulmonary neuroendocrine neoplasms (NENs) has expanded significantly, particularly through elucidation of molecular pathways and proposals to refine the histopathological classification. This expanded knowledge across all aspects of pulmonary NENs holds promise for more precise stratification of neuroendocrine tumors (NETs) and potential development of novel, subtype-specific therapeutic strategies for all NENs. Based on our comprehensive review of the current pulmonary NEN landscape, our multidisciplinary expert panel has deliberated on the modification and updating of the 2021 classification, resulting in the proposal of the new pulmonary carcinoid/NET classification presented in this position paper, incorporating three major points: 1) The proposed framework continues the shift from the traditional carcinoid terminology toward broader adoption of the "NET" nomenclature as seen in other organ systems while retaining the term "carcinoid" as the primary diagnostic term to ensure clear communication with thoracic clinical providers. 2) Ki-67 has been incorporated as a diagnostic criterion, aligning with practices in other NET classifications, and 3) Formal recognition of the concept of "carcinoid/NET G3", a rare subset of lung carcinoids characterized by increased proliferative activity but molecular features more aligned with pulmonary NETs than high-grade neuroendocrine carcinomas. This position paper on the current knowledge of pulmonary NENs, including the proposed carcinoid/NET classification, will aid accurate tumor categorization and guide treatment strategies.

MeSH

Thoracic Neoplasms, Neoplasms, Classification, Small Cell Lung Carcinoma, Therapeutics, Carcinoid Tumor, Carcinoma, Neuroendocrine