Treatment and survival after lung resection for non-small cell lung cancer in patients with microscopic residual disease at the bronchial stump

Ghiribelli, Claudia; Voltolini, Luca; Paladini, Piero; Luzzi, Luca; Bisceglie, M. Di; Gotti, Giuseppe

doi:10.1016/s1010-7940(99)00310-3

Cited by 56 publications

(58 citation statements)

References 12 publications

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“…20 Many but not all studies of positive margins of surgically treated lung cancers have shown adverse impact by residual disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Microscopic residual tumor at the bronchial resection margin has then been divided into different patterns. Cotton 1 first divided microscopic residual disease into mucosal tumor (spreading from a mucosal lesion), and extramucosal microscopic residual disease (tumor involving peribronchial soft tissues or tumor within lymphatics).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, Ghiribelli divided residual microscopic diseases into mucosal and extramucosal tumor, but found no difference in survival between these patterns. 4 Lymphatic space involvement at the bronchial margin has been shown to be an adverse prognostic factor in many studies. 16,9,12 Gross evaluation of bronchial margins are known to be problematic.…”

Section: Discussionmentioning

confidence: 99%

“…To this end, resection margins should be uninvolved with tumor. Many surgical series have demonstrated adverse patient outcome with either microscopic or macroscopic residual tumor at the bronchial resection margin, [1][2][3][4][5][6][7][8][9][10][11][12][13] and thus it is usually assumed that negative margins give the best chance for local control. However, poor outcomes with residual microscopic disease have not been reported by all authors.…”

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confidence: 99%

“…[14][15][16] Surgical and pathologic methods vary to determine negative margins intraoperatively. Some authors recommend frozen sections of bronchial margins in all cases, 4,17 while others recommend primarily gross evaluation with frozens reserved for cases in which tumor is within a defined distance of the margin. 18,19 Distinctions have also been made about different prognosis for positive margins of mucosal bronchial carcinoma (in situ and/or invasive tumor involving mucosa or submucosa), extramucosal peribronchial invasive carcinoma, and carcinoma within lymphatics at the bronchial margin.…”

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confidence: 99%

“…18,19 Distinctions have also been made about different prognosis for positive margins of mucosal bronchial carcinoma (in situ and/or invasive tumor involving mucosa or submucosa), extramucosal peribronchial invasive carcinoma, and carcinoma within lymphatics at the bronchial margin. [4][5][6][7]9,11,17 In spite of the voluminous (and often conflicting) literature on this topic in the clinical cardiothoracic literature, little has been written in pathology journals about indications for frozen sections and gross evaluation of tumor distance to margins. This study was undertaken to look at the experience of bronchial margin evaluation at one institution, and to relate final margin status with gross distance from tumor, frozen section results and tumor type.…”

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Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

2004

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Pathology reports for all lobectomy and pneumonectomy specimens at UNC Hospitals between 1991 and 2000 (n ¼ 405) were reviewed for correlation between frozen section and final bronchial margin, gross distance between tumor and margin and tumor type. Frozen section was performed in 268 cases (66%). A total of 243 were true negatives (90.6 %), 16 (6.0%) were true positives, four (1.5%) were false positives and five (1.9%) were false negatives. The site of tumor in true-positive cases was mucosal (11), submucosal (three), lymphatics (one), peribronchial (one). The site of tumor in false-negative cases was submucosal (two), lymphatics (one), peribronchial (two). In 137 cases, no bronchial frozen section was performed; there was one case (0.7%) with positive margin. There was no correlation between final margin positivity and distance between gross tumor and margin. Tumor distance to margin in positive margin cases varied from grossly involved to 3 cm away. There were 72 cases in which wedge resection was performed before lobectomy in which no gross tumor remained in the lobectomy, and in all cases final bronchial margins were negative. In all, 373 of cases (92%) were nonsmall carcinomas. Of these, 10 (2.7%) had positive margins. Tumors other than nonsmall cell carcinoma accounted for a disproportionate number of positive margins. In all, 3/6 of adenoid cystic/ mucoepidermoid carcinoma, 1/7 small cell carcinoma and 1/1 lymphoma cases had positive margins. In conclusion, frozen section evaluation of bronchial margins is helpful in central lung tumors. Mucosal tumor is preferentially identified in frozen section. Gross evaluation of margins is problematic, as intramucosal carcinoma or tumor in lymphatics may not be detected, but 3 cm was a 'safe' distance for gross tumor from margin. In lobectomies following wedge resection in which no gross tumor remained, all had negative margins. Salivary gland-type tumors have a high incidence of positive margins, and frozen section is particularly indicated in these tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

2004

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Recurrence/prognosis estimation using a molecularly positive surgical margin‐based model calls for alternative curative strategies in pIIIA/N2 NSCLC

Li,

He,

Zhou

et al. 2024

Molecular Oncology

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Stage pIIIA/N2 non‐small cell lung cancer (NSCLC) is primarily treated by complete surgical resection combined with neoadjuvant/adjuvant therapies. However, up to 40% of patients experience tumor recurrence. Here, we studied 119 stage pIIIA/N2 NSCLC patients who received complete surgery plus adjuvant chemotherapy (CT) or chemoradiotherapy (CRT). The paired tumor and resection margin samples were analyzed using next‐generation sequencing (NGS). Although all patients were classified as negative resection margins by histologic methods, NGS revealed that 47.1% of them had molecularly positive surgical margins. Patients who tested positive for NGS‐detected residual tumors had significantly shorter disease‐free survival (DFS) (P = 0.002). Additionally, metastatic lymph node ratio, erb‐b2 receptor tyrosine kinase 2 (ERBB2) mutations, and SWI/SNF‐related, matrix‐associated, actin‐dependent regulator of chromatin, subfamily a, member 4 (SMARCA4) mutations were also independently associated with DFS. We used these four features to construct a COX model that could effectively estimate recurrence risk and prognosis. Notably, mutational profiling through broad‐panel NGS could more sensitively detect residual tumors than the conventional histologic methods. Adjuvant CT and adjuvant CRT exhibited no significant difference in eliminating locoregional recurrence risk for stage pIIIA/N2 NSCLC patients with molecularly positive surgical margins.

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Clinical implications of positive margins following non‐small cell lung cancer surgery

Predina

Keating

Patel

et al. 2015

Journal of Surgical Oncology

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Positive margins following pulmonary resection of non-small cell lung cancer (NSCLC) occur in approximately 5-15% of patients undergoing a curative procedure. The presence of positive margins negatively impacts long-term outcomes by setting the stage for local and potentially distant disease recurrence. Despite major clinical ramifications, there are very few dedicated reports that examine the implications of positive margins following surgery for NSCLC. Furthermore, published series are typically retrospective studies from single institutions. In this review we analyze published data with special consideration of four pertinent questions: (i) what are the long term outcomes of a positive margin following pulmonary resection?, (ii) is intraoperative margin assessment by frozen section reliable?, (iii) what is the optimal distance of the tumor margin to the surgical margin?, and (iv) should adjuvant chemotherapy and/or radiation therapy be used in the setting of a positive surgical margin?

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Treatment and survival after lung resection for non-small cell lung cancer in patients with microscopic residual disease at the bronchial stump

Cited by 56 publications

References 12 publications

Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

Recurrence/prognosis estimation using a molecularly positive surgical margin‐based model calls for alternative curative strategies in pIIIA/N2 NSCLC

Clinical implications of positive margins following non‐small cell lung cancer surgery

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