Application and progress of non-invasive imaging in predicting lung invasive non-mucinous adenocarcinoma under the new IASLC grading guidelines.

Lung cancer is the leading cause of cancer-related deaths worldwide, with invasive non-mucinous adenocarcinoma (INMA) being the most common type and carrying a poor prognosis. In 2020, the International Association for the Study of Lung Cancer (IASLC) pathology committee proposed a new histological grading system, which offers more precise prognostic assessments by combining the proportions of major and high-grade histological patterns. Accurate identification of lung INMA grading is crucial for clinical diagnosis, treatment planning, and prognosis evaluation. Currently, non-invasive imaging methods (such as CT, PET/CT, and MRI) are increasingly being studied to predict the new grading of lung INMA, showing promising application prospects. This review outlines the establishment and prognostic efficiency of the new IASLC grading system, highlights the application and latest progress of non-invasive imaging techniques in predicting lung INMA grading, and discusses their role in personalized treatment of lung INMA and future research directions. CRITICAL RELEVANCE STATEMENT: The new IASLC grading system has important prognostic implications for patients with lung invasive non-mucinous adenocarcinoma (INMA), and non-invasive imaging methods can be used to predict it, thereby improving patient prognoses. KEY POINTS: The new IASLC grading system more accurately prognosticates for patients with lung INMA. Preoperative prediction of the new grading is challenging because of the complexity of INMA subtypes. It is feasible to apply non-invasive imaging methods to predict the new IASLC grading system.