Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Histopathology. 2022 Jul;81(1):119-127. doi: 10.1111/his.14672. Epub 2022 May 18.
The presence of micropapillary (MIP) in early-stage lung adenocarcinoma is associated with a poorer prognosis, especially in patients undergoing sublobectomy. However, data on the sensitivity of frozen section (FS) evaluation of MIP is still limited. We included the concept of a filigree pattern on FS to assess its effect on the diagnostic sensitivity and specificity of MIP, and to verify its prognostic value in stage T1 lung adenocarcinoma.
A panel of five pathologists evaluated 125 patients with T1 lung adenocarcinoma from January to February 2014 as a study cohort, and 151 patients from January to February 2020 as a validation cohort. The diagnostic accuracy of the filigree and classical micropapillary (cMIP) pattern on FS was investigated.
The diagnostic sensitivity of the MIP pattern on FS increased from 43.2% to 65.3% and 56.8% to 81.1% in the study cohort and validation cohort, respectively, and both with good specificity. Filigree not only increased the sensitivity of identifying MIP when there was an absence of cMIP, but also increased the sensitivity when the presence of a minor amount of cMIP. The almost perfect agreement among five pathologists was reached on cMIP and substantial agreement was reached on the filigree in the two cohorts. Moreover, the cMIP and filigree were both correlated with poorer recurrence-free survival (p = 0.003; p = 0.032) and overall survival (p = 0.004; p = 0.005).
The identification of a filigree may improve the diagnostic sensitivity of the MIP pattern on FS. FS was feasible for the detection of filigree and cMIP patterns in stage T1 lung adenocarcinomas.
微乳头（MIP）在早期肺腺癌中的存在与预后较差相关，尤其是在接受亚肺叶切除术的患者中。然而，关于冷冻切片（FS）评估 MIP 的敏感性的数据仍然有限。我们在 FS 上纳入了线状模式的概念，以评估其对 MIP 诊断敏感性和特异性的影响，并验证其在 T1 期肺腺癌中的预后价值。
一组五名病理学家于 2014 年 1 月至 2 月评估了 125 例 T1 期肺腺癌患者作为研究队列，于 2020 年 1 月至 2 月评估了 151 例患者作为验证队列。研究了 FS 上线状和经典微乳头（cMIP）模式的诊断准确性。
在研究队列和验证队列中，FS 上 MIP 模式的诊断敏感性分别从 43.2%增加到 65.3%和 56.8%增加到 81.1%，且特异性均较好。线状不仅在没有 cMIP 时增加了识别 MIP 的敏感性，而且在存在少量 cMIP 时也增加了敏感性。在两个队列中，五名病理学家之间达到了几乎完美的一致性，并且在线状方面达到了实质性的一致性。此外，cMIP 和线状均与无复发生存率（p=0.003;p=0.032）和总生存率（p=0.004;p=0.005）较差相关。
线状的识别可能会提高 FS 上 MIP 模式的诊断敏感性。FS 可用于检测 T1 期肺腺癌中的线状和 cMIP 模式。
