Ann Thorac Surg 2005;80:2007
© 2005 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Norman J. Snow, MD
Division of Cardiothoracic Surgery, University of Illinois, Chicago, 840 S Wood St, Suite 417 (M/C 958), Chicago, IL 60612-7322
(Email: nsnow{at}uic.edu).
The manuscript by Fang and colleagues [1] confirms earlier validation of the utility of the World Health Organization histologic classification of thymic epithelial tumors with respect to prognosis and operative risks. However, one must use caution in making preoperative clinical decisions based on minimally invasive biopsies. The anatomic (Masaoka) staging is usually clinically apparent on the computed tomographic scan. If the Masaoka stage is equivocal (ie, it is unclear whether there is mediastinal invasion), then the World Health Organization classification is likely to be helpful because B2, B3, and C lesions are usually anatomically advanced as well. However there is no clear evidence that on an individual case by case basis, clear cut decisions regarding surgery can reliably be made. B2 lesions are often resectable for cure whereas A lesions may be invasive.
It is imperative that the minimally invasive staging (ie, needle biopsy or video-assisted thoracic surgery) must yield a histologic rather than a cytologic specimen in order to achieve optimal reliability.
If we make available neoadjuvant protocols, and there is promising early evidence for its efficacy, then the histologic World Health Organization classification will be essential to perioperative planning. If surgery remains the principal therapy, then we must continue to judge each patient by the resectability of the tumor and utilize the histologic information for planning adjuvant treatment and for prognosis.
It is unclear from the data whether advanced World Health Organization classification is actually a risk factor itself or a surrogate for more advanced disease, which is prone to technical misadventures.
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References
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- Fang W, Chen W, Chen G, Jiang Y. Surgical management of thymic epithelial tumorsa retrospective review of 204 cases. Ann Thorac Surg 2005;80:2002-2007.[Abstract/Free Full Text]
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