Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: an analysis of 136 cases

Abstract

Diagnosis of AIS and MIA from intraoperative frozen sections is feasible. We provide several modifications that may improve the diagnostic accuracy of intraoperative frozen sections for early-stage lung adenocarcinoma.

Joint use of the radiomics method and frozen sections should be considered in the prediction of the final classification of peripheral lung adenocarcinoma manifesting as ground-glass nodules

“…Currently, the intraoperative pathological classification of early lung adenocarcinoma is mainly obtained by FS. One study [12] analyzed 136 patients with early lung adenocarcinoma, and found that the concordance rate between FS and paraffin sections was only 63.24 %, finding that FS gave a deferral diagnosis(could only provide a diagnosis of adenocarcinoma, where the pathological classification was unclear) in approximately 32.35 % of all cases. In an analysis [14] of 224 consecutive primary pulmonary adenocarcinomas, the FS errors and deferrals were identified in 12.1 % and 6.3 % of the cases, respectively.…”

“…These results proved that the diagnostic performance of our radiomics method is not inferior to frozen sections. In the studies conducted by He P et al and Walts AE et al [12,14], the FS deferrals were identified as 32.35 % and 6.3 % of all the cases, respectively, which would lead to inappropriate surgical treatment, the introduction of a new method to solve this problem is necessary. Therefore, it is meaningful that radiomics serve as a reliable complementary method for the pathological classification of the cases where FS can't give timely diagnosis.…”

“…FS currently plays a main role in the intraoperative diagnosis and classification of early lung adenocarcinoma, guiding the surgery treatment. However, the classification accuracy of FS is unsatisfactory, and for some cases, it cannot give timely pathological classification due to the poor quality or sampling problems (FS deferrals), [12][13][14][15]. This may lead to an inappropriate surgical strategy and even a second surgery for patients [11,14,15].…”

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

“…Additionally, tumor size had a significant influence on the concordance rate. Another retrospective study from China reported that the concordance rate in diagnosis of AIS and MIA was 95.6% among 136 patients with AIS or MIA ≤3 cm . Of note, further histologic subtyping including detection of high grade histology on frozen section was not attempted in both studies.…”

Challenges of Frozen Section in Thoracic Pathology: Lepidic Lesions, Limited Resections, and Margins

“…In one series, other features that caused diagnostic challenges included lack of cytologic atypia and the presence of fibrosis or inflammation. 22 However, in experienced centers, accuracy rates are high even for adenocarcinoma in situ and minimally invasive adenocarcinoma, 23 despite these caveats. Nevertheless, it is difficult to uniformly recommend definitive assessment by frozen section alone, but rather a clinical and radiologic comparison with frozen section during intraoperative consultation seems a more rational approach to mitigate the effect of sampling.…”