Cao Hang, Zheng Qiang, Deng Chaoqiang, Fu Zichen, Shen Xuxia, Jin Yan, Yang Yongguo, Qian Bin, Yuan Chunyan, Wang Weihua, Zhang Lei, Song Qingping, Zuo Shuying, Ma Junjie, You Shuqing, Zheng Senzhong, Gao Qingli, Su Guangli, Zhang Yang, Chen Haiquan, Li Yuan
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China.
Ann Surg. 2024 Sep 6. doi: 10.1097/SLA.0000000000006525.
To investigate the value of intraoperative assessment of spread through air spaces (STAS) on frozen sections (FS) in peripheral small-sized lung adenocarcinoma.
Surgical decision-making based on FS diagnosis of STAS may be useful to prevent local control failure after sublobar resection.
We conducted a multicenter prospective observational study of consecutive patients with cT1N0M0 invasive lung adenocarcinoma to evaluate the accuracy of FS for the intraoperative detection of STAS. The final pathology (FP) diagnosis of STAS was based on corresponding permanent paraffin sections.
This study included 878 patients with cT1N0M0 invasive lung adenocarcinoma. A total of 833 cases (95%) were assessable for STAS on FS. 26.4% of the cases evaluated positive for STAS on FP, whereas 18.2% on FS. The accuracy, sensitivity, and specificity of FS diagnosis of STAS were 85.1%, 56.4%, and 95.4%, respectively, with moderate agreement (κ=0.575). Inter-observer agreement was substantial (κ=0.756) among the three pathologists. Subgroup analysis based on tumor size or consolidation-to-tumor ratio all showed moderate agreement for concordance. After rigorous reassessment of false-positive cases, the presence of artifacts may be the main cause of interpretation errors. Additionally, true positive cases showed more high-grade histological patterns and more advanced p-TNM stages than false negative cases.
This is the largest prospective observational study to evaluate STAS on FS in patients with cT1N0M0 invasive lung adenocarcinoma. FS is highly specific with moderate agreement, but is not sensitive for STAS detection. While appropriately reporting STAS on FS may provide surgeons with valuable information for intraoperative decision-making, better approaches are needed.
探讨术中冰冻切片（FS）评估周围型小肺癌气腔播散（STAS）的价值。
基于FS诊断STAS进行手术决策可能有助于预防亚肺叶切除术后局部控制失败。
我们对连续的cT1N0M0浸润性肺腺癌患者进行了一项多中心前瞻性观察研究，以评估FS术中检测STAS的准确性。STAS的最终病理（FP）诊断基于相应的永久性石蜡切片。
本研究纳入878例cT1N0M0浸润性肺腺癌患者。共有833例（95%）可在FS上评估STAS。26.4%的病例在FP上STAS评估为阳性，而在FS上为18.2%。FS诊断STAS的准确性、敏感性和特异性分别为85.1%、56.4%和95.4%，一致性中等（κ=0.575）。三位病理学家之间的观察者间一致性较高（κ=0.756）。基于肿瘤大小或实变与肿瘤比例的亚组分析均显示一致性中等。在对假阳性病例进行严格重新评估后，伪像的存在可能是解释错误的主要原因。此外，真阳性病例比假阴性病例表现出更多的高级别组织学模式和更晚的p-TNM分期。
这是评估cT1N0M0浸润性肺腺癌患者FS上STAS的最大规模前瞻性观察研究。FS具有高度特异性，一致性中等，但对STAS检测不敏感。虽然在FS上适当报告STAS可能为外科医生提供术中决策的有价值信息，但仍需要更好的方法。
