Visceral pleural invasion

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Visceral pleural invasion is a feature that can be seen in lung cancers. It is defined as tumor extension beyond the elastic layer of the visceral pleura. It is considered an aggressive sign and one of the most important adverse prognostic factors in non-small cell lung cancers .

Pathology

Grading

There are three described levels of invasion (based on histology):

PL0: represents tumor invading either the subpleural lung parenchyma or superficially the pleural connective tissue beneath the elastic layer
PL1: refers to a tumor that invades beyond the elastic layer without being exposed on the pleural surface
PL2: refers to a tumor that is exposed on the pleural surface, but it does not involve adjacent anatomic structures

Radiographic features

CT

The presence of type 2 pleural tags has been shown to have a moderate association with visceral pleural invasion.

Treatment and prognosis

According to one study, there was ~20% (range 10-30%) worse 5-year survival in tumors with visceral pleural invasion compared to those without visceral pleural invasion.