Spread through air spaces (STAS): a comprehensive update

Warth, Arne

doi:10.21037/tlcr.2017.06.08

Cited by 66 publications

(52 citation statements)

References 33 publications

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“…Spread through air spaces (STAS) is a recently recognized invasive pattern of lung cancer, defined as "micropapillary clusters, solid nests or single cells beyond the edge of the tumor into air spaces." 5 Although first introduced by Kadota et al in 2015, 6 similar concepts, including aerogenous spread with floating cancer cell clusters and tumor islands, have been reported. [7][8][9] Although the definite mechanisms of STAS have yet to be elucidated, several studies have shown an association with male gender, a history of smoking, and clinicopathologically invasive features, such as larger tumor diameter, the presence of pleural invasion, and histologically invasive types.…”

Section: Introductionmentioning

confidence: 92%

“…Spread through air spaces (STAS) is a recently recognized invasive pattern of lung cancer, defined as “micropapillary clusters, solid nests or single cells beyond the edge of the tumor into air spaces.” Although first introduced by Kadota et al . in 2015, similar concepts, including aerogenous spread with floating cancer cell clusters and tumor islands, have been reported .…”

Section: Introductionmentioning

confidence: 99%

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Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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BackgroundIn early‐stage lung adenocarcinomas, spread through air spaces (STAS) are reported to be a prognostic factor in patients who have undergone sublobar resection, but not lobectomy. In contrast, reports have also shown that STAS is significantly associated with poor survival outcomes after lobectomy, but not after limited resection. Thus, the prognostic impact of STAS differs according to published reports.MethodsA total of 82 patients with early‐stage adenocarcinomas who underwent limited resection and whose STAS status could be examined were enrolled in this retrospective study. We evaluated the association between STAS and clinicopathological characteristics and postoperative survival.ResultsAmong 82 patients, 31 (37.8%) were positive for STAS, while 51 (62.2%) were negative. STAS was significantly associated with advanced tumor stage (P < 0.01), lower histological differentiation (P = 0.01), and the presence of pleural invasion (P = 0.01). Patients with STAS had significantly shorter recurrence‐free survival (RFS) and overall survival (OS) than those without STAS (P < 0.01 and P = 0.02, respectively). According to multivariate analysis, positivity for STAS was an independent prognostic parameter for RFS (P < 0.01), but not OS (P = 0.45). Three patients who developed surgical margin recurrence and one patient who developed distant recurrence were all positive for STAS.ConclusionsSTAS was predictive of poor postoperative survival in patients with early‐stage adenocarcinomas treated with limited resection and was associated with surgical margin recurrence.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

et al. 2018

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“…The histopathologic evaluation of lung cancer resection specimens involves assessment of tumor features with prognostic significance, such as lymphovascular invasion or pleural invasion. Recent studies have highlighted the significance of a new pattern of tumor spread in lung carcinomas, referred to as tumor spread through air spaces (STAS) . STAS was formally introduced in the 2015 World Health Organization classification for pulmonary carcinomas, which defined STAS as tumor cells present singly or in micropapillations, clusters, or solid nests within alveolar spaces of the lung parenchyma beyond the main tumor edge .…”

Section: Introductionmentioning

confidence: 99%

Preoperative bronchial cytology for the assessment of tumor spread through air spaces in lung adenocarcinoma resection specimens

Medina

Onken

Margerie-Mellon

et al. 2020

Cancer Cytopathology

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BACKGROUND: Tumor spread through air spaces (STAS), a significant prognostic indicator, has been described recently as a pattern of invasion in pulmonary carcinomas. However, questions remain regarding preoperative identification of STAS and whether it represents an in vivo phenomenon versus an ex vivo artifact. METHODS: We retrospectively reviewed 67 paired preoperative bronchoalveolar lavage (BAL) or bronchial washing (BW) cytology specimens with the subsequent lung adenocarcinoma surgical resection specimen to determine whether preoperative cytology could predict STAS. Other clinical, radiologic, and pathologic features of the resected lesions were also correlated with preoperative bronchial cytology results. RESULTS:Positive bronchial cytology was observed in 28 cases (41.8%), 24 of which had STAS (85.7%); however, negative BAL/BW cytology was observed in 39 cases (58.2%), 29 of which had STAS (74.4%) (x 2 = 1.27, P = .26, not significant). High-STAS burden was observed in 44 cases (83.0%), 21 (47.7%) with negative BAL/BW and 23 (52.3%) with positive BAL/BW. Low-STAS burden was observed in 9 cases (17.0%), 8 (88.9%) with negative BAL/BW and only 1 (11.1%) with positive BAL/BW (x 2 = 5.11, P = .024, significant). For tumors with STAS, a statistically significant difference was identified in the maximal STAS distance from the main tumor edge between BAL/BW-positive and BAL/BW-negative groups (P = .007). Of the remaining clinicopathologic and radiologic features, only visceral pleural invasion was significantly associated with BAL/BW positivity. CONCLUSION:Presurgical bronchial cytology alone cannot adequately predict tumor STAS; however, it may provide useful information regarding the extent and overall burden of STAS on the subsequent resection specimen. Cancer Cytopathol 2020;128:278-286.

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“…[2,3]The conception of STAS was rst introduced into our vision by Kadota and colleagues in 2015 [4].In the 2015 World Health Organization(WHO) Classi cation [5], STAS was newly recognized as a pattern of tumor spread in lung adenocarcinoma. STAS is de ned as micropapillary clusters, solid nests, or single cells spreading within air spaces beyond the edge of the main tumor [6]. STAS can be found in 14.8 to 56.4% of lung adenocarcinomas and has been proven to be a risk factor for survival and reoccurrence after operation [4,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Association between CT-based Features and Tumor Spread Through Air Spaces in Lung Adenocarcinoma

Yin

Wang

Cui

et al. 2020

Preprint

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Objective：Spread through air space (STAS) is a novel invasive pattern of lung adenocarcinoma and is also a risk factor for recurrence and worse prognosis of lung adenocarcinoma after sublobar resection. The aims of this study are to evaluate the association between computed tomography (CT)-based features and STAS for preoperative prediction of STAS in lung adenocarcinoma, eventually, which could help us choose appropriate surgical type. Methods：Systematic research was conducted to search for studies published before September 1, 2019. The association between CT-based features of radiological tumor size＞2cm、pure solid nodule、 part-solid nodule or Percentage of solid component(PSC)＞50% and STAS was evaluated. According to rigorous inclusion and exclusion criteria. Eight studies including 2,385 patients published between 2015 and 2018 were finally enrolled in our meta-analysis.Results：Our results clearly depicted that there is no significant relationship between radiological tumor size＞2cm and STAS with the combined OR of 1.47(95% CI:0.86-2.51). Meta-analysis of 3 studies showed that pure solid nodule in CT image were more likely to spread through air spaces with pooled OR of 3.10(95%CI2.17-4.43). Meta-analysis of 5 studies revealed the part-solid nodule in CT image may be more likely to appear STAS in adenocarcinoma (ADC) (combined OR:3.10,95%CI:2.17-4.43). PSC＞50% in CT image was a significant independent predictor in the diagnosis of STAS in ADC from our meta-analysis with combined OR of 2.95(95%CI:1.88-4.63).Conclusion：In conclusion, The CT-based features of pure solid nodule、part-solid nodule、PSC＞50% are promising imaging biomarkers for predicting STAS in ADC and may substantially influence the choice of surgical type. In future, more studies with well-designed and large-scale are needed to confirm the conclusion.

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Spread through air spaces (STAS): a comprehensive update

Cited by 66 publications

References 33 publications

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Significance of spread through air spaces in early‐stage lung adenocarcinomas undergoing limited resection

Preoperative bronchial cytology for the assessment of tumor spread through air spaces in lung adenocarcinoma resection specimens

Meta-Analysis of Association between CT-based Features and Tumor Spread Through Air Spaces in Lung Adenocarcinoma

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