11189例病灶小于2cm肺腺癌冷冻切片诊断回顾分析
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摘要
目的由于原位腺癌(AIS)及微浸润性腺癌(MIA)预后良好,当体积较小(≤2 cm)时外科可采用亚肺叶切除。我们对2015—2017年间最大径≤2 cm的肺腺癌冷冻诊断进行回顾性分析,对比冷冻切片诊断与石蜡切片诊断,分析二者的符合率。方法此次研究共收集11189例小体积肺肿瘤冷冻诊断病例,以浸润程度和对手术影响进行分组,并行统计分析各组冷冻切片诊断与石蜡切片诊断的符合率。结果 AIS符合率为82.81%,MIA符合率为76.42%,浸润性腺癌符合率为88.39%,黏液型腺癌符合率为99.36%,转移性腺癌符合率为99.83%,亚肺叶切除的诊断符合率为88.69%。13.04%的病例冷冻诊断无法对手术方式做出建议。结论浸润性肺腺癌冷冻切片诊断符合率高,小体积早期肺腺癌术中冷冻切片与石蜡切片诊断存在一定不符合率,部分病例无法在冷冻中确诊,需要在临床实际工作中加强与胸外科医师的沟通和理解。
Objective Considering the good prognosis of adenocarcinoma in situ(AIS) and minimal invasive adenocarcinoma(MIA), and these lung cancer cases could be performed as sublobar resections while the tumor size is no more than 2 cm. We started the retrospective study to analyze the accuracy of frozen section diagnosis from 2015 to 2017 comparing the paraffin section diagnosis. Methods We collected 11189 small-sized lung adenocarcinoma cases, divided the cases into several groups as the invasion level and the impact of the surgery, with statistical analysis to find out the frozen section diagnosis accuracy of these groups. Results The accuracy of AIS diagnosis was 82.81%, the accuracy of MIA was 76.42%, the accuracy of invasive adenocarcinoma was 88.39%, the accuracy of mucinous adenocarcinoma was 99.36%, and the accuracy of metastatic carcinoma was 99.83%. The accuracy of sublobar resection diagnosis was 88.69%. There were 13.04% equivocal frozen section diagnosis for surgery. Conclusions The accuracy of invasive lung adenocarcinoma is high. However, some frozen section diagnosis of small size early stage lung adenocarcinomas(AIS and MIA) do not match the final diagnosis, some cases cannot be confirmed in frozen section diagnosis. Pathologists must communicate with thoracic surgeons for mutual understanding.
Objective Considering the good prognosis of adenocarcinoma in situ(AIS) and minimal invasive adenocarcinoma(MIA), and these lung cancer cases could be performed as sublobar resections while the tumor size is no more than 2 cm. We started the retrospective study to analyze the accuracy of frozen section diagnosis from 2015 to 2017 comparing the paraffin section diagnosis. Methods We collected 11189 small-sized lung adenocarcinoma cases, divided the cases into several groups as the invasion level and the impact of the surgery, with statistical analysis to find out the frozen section diagnosis accuracy of these groups. Results The accuracy of AIS diagnosis was 82.81%, the accuracy of MIA was 76.42%, the accuracy of invasive adenocarcinoma was 88.39%, the accuracy of mucinous adenocarcinoma was 99.36%, and the accuracy of metastatic carcinoma was 99.83%. The accuracy of sublobar resection diagnosis was 88.69%. There were 13.04% equivocal frozen section diagnosis for surgery. Conclusions The accuracy of invasive lung adenocarcinoma is high. However, some frozen section diagnosis of small size early stage lung adenocarcinomas(AIS and MIA) do not match the final diagnosis, some cases cannot be confirmed in frozen section diagnosis. Pathologists must communicate with thoracic surgeons for mutual understanding.
引文
[1] Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma[J]. J Thorac Oncol,2011,6(2):244-285.
[2] Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol,2015,10(9):1243-1260.
[3] Woo T, Okudela K, Mitsui H, et al. Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases[J]. Pathol Int,2012,62(12):785-791.
[4] Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases[J]. Mod Pathol,2011,24(5):653-664.
[5] Jones DR, Stiles BM, Denlinger CE, et al. Pulmonary segmentectomy: results and complications[J]. Ann Thorac Surg,2003,76(2):343-348, 348-349.
[6] Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer[J]. Ann Thorac Surg,2007,84(3):926-932, 932-933.
[7] Hattori A, Matsunaga T, Takamochi K, et al. Indications for sublobar resection of clinical stage IA radiologic pure-solid lung adenocarcinoma[J]. J Thorac Cardiovasc Surg,2017,154(3):1100-1108.
[8] Moon Y, Lee KY, Park JK. Prognosis after sublobar resection of small-sized non-small cell lung cancer with visceral pleural or lymphovascular invasion[J]. World J Surg,2017,41(11):2769-2777.
[9] Van Schil PE, Asamura H, Rusch VW, et al. Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification[J]. Eur Respir J,2012,39(2):478-486.
[10] Walts AE, Marchevsky AM. Root cause analysis of problems in the frozen section diagnosis of in situ, minimally invasive, and invasive adenocarcinoma of the lung[J]. Arch Pathol Lab Med,2012,136(12):1515-1521.
[11] Yeh YC, Nitadori JI, Kadota K, et al. Using frozen section to identify histological patterns in stage I lung adenocarcinoma of ≤3 cm: accuracy and interobserver agreement[J]. Histopathology,2015,66(7):922-938.
[12] Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma[J]. J Clin Oncol,2016,34(4):307-313.
[13] He P, Yao G, Guan Y, et al. Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: an analysis of 136 cases[J]. J Clin Pathol,2016,69(12):1076-1080.
[14] Travis WD, Brambilla E, Burke AP, et al. WHO classfication of tumours of the lung, pleura, thymus and heart.4th ed. lyon:international agency for research on cancer, 2015.
[15] Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer[J]. J Thorac Oncol,2016,11(1):39-51.
[16] Blasberg JD, Pass HI, Donington JS. Sublobar resection: a movement from the lung cancer study group[J]. J Thorac Oncol,2010,5(10):1583-1593.
[17] Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules[J]. J Thorac Cardiovasc Surg,2014,147(2):754-762, 762-764.
[18] Aberle DR, Demello S, Berg CD, et al. Results of the two incidence screenings in the national lung screening trial[J]. N Engl J Med,2013,369(10):920-931.
[19] Aberle DR, Berg CD, Black WC, et al. The national lung screening trial: overview and study design[J]. Radiology,2011,258(1):243-253.
[20] Kent M, Landreneau R, Mandrekar S, et al. Segmentectomy versus wedge resection for non-small cell lung cancer in high-risk operable patients[J]. Ann Thorac Surg,2013,96(5):1747-1754, 1754-1755.
[21] Nakao M, Yoshida J, Goto K, et al. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules[J]. J Thorac Oncol,2012,7(10):1563-1566.
[22] 董元焕, 孙蕾, 战忠利,等. 1138例肺部肿物术中冰冻诊断结果分析[J]. 中国肿瘤临床,2011,38(22):1403-1407.
[23] Marchevsky AM, Changsri C, Gupta I, et al. Frozen section diagnoses of small pulmonary nodules: accuracy and clinical implications[J]. Ann Thorac Surg,2004,78(5):1755-1759.
[24] Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections[J]. Mod Pathol,2015,28(8):1058-1063.
[25] Myung JK, Choe G, Chung DH, et al. A simple inflation method for frozen section diagnosis of minute precancerous lesions of the lung[J]. Lung Cancer,2008,59(2):198-202.
[26] Matsushima J, Yazawa T, Suzuki M, et al. Clinicopathological, immunohistochemical and mutational analyses of pulmonary enteric adenocarcinoma: usefulness of SATB2 and beta-catenin immunostaining for differentiation from metastatic colorectal carcinoma[J]. Hum Pathol,2017,64:179-185.
[27] Wang CX, Liu B, Wang YF, et al. Pulmonary enteric adenocarcinoma: a study of the clinicopathologic and molecular status of nine cases[J]. Int J Clin Exp Pathol,2014,7(3):1266-1274.
[2] Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol,2015,10(9):1243-1260.
[3] Woo T, Okudela K, Mitsui H, et al. Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases[J]. Pathol Int,2012,62(12):785-791.
[4] Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases[J]. Mod Pathol,2011,24(5):653-664.
[5] Jones DR, Stiles BM, Denlinger CE, et al. Pulmonary segmentectomy: results and complications[J]. Ann Thorac Surg,2003,76(2):343-348, 348-349.
[6] Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer[J]. Ann Thorac Surg,2007,84(3):926-932, 932-933.
[7] Hattori A, Matsunaga T, Takamochi K, et al. Indications for sublobar resection of clinical stage IA radiologic pure-solid lung adenocarcinoma[J]. J Thorac Cardiovasc Surg,2017,154(3):1100-1108.
[8] Moon Y, Lee KY, Park JK. Prognosis after sublobar resection of small-sized non-small cell lung cancer with visceral pleural or lymphovascular invasion[J]. World J Surg,2017,41(11):2769-2777.
[9] Van Schil PE, Asamura H, Rusch VW, et al. Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification[J]. Eur Respir J,2012,39(2):478-486.
[10] Walts AE, Marchevsky AM. Root cause analysis of problems in the frozen section diagnosis of in situ, minimally invasive, and invasive adenocarcinoma of the lung[J]. Arch Pathol Lab Med,2012,136(12):1515-1521.
[11] Yeh YC, Nitadori JI, Kadota K, et al. Using frozen section to identify histological patterns in stage I lung adenocarcinoma of ≤3 cm: accuracy and interobserver agreement[J]. Histopathology,2015,66(7):922-938.
[12] Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma[J]. J Clin Oncol,2016,34(4):307-313.
[13] He P, Yao G, Guan Y, et al. Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: an analysis of 136 cases[J]. J Clin Pathol,2016,69(12):1076-1080.
[14] Travis WD, Brambilla E, Burke AP, et al. WHO classfication of tumours of the lung, pleura, thymus and heart.4th ed. lyon:international agency for research on cancer, 2015.
[15] Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer[J]. J Thorac Oncol,2016,11(1):39-51.
[16] Blasberg JD, Pass HI, Donington JS. Sublobar resection: a movement from the lung cancer study group[J]. J Thorac Oncol,2010,5(10):1583-1593.
[17] Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules[J]. J Thorac Cardiovasc Surg,2014,147(2):754-762, 762-764.
[18] Aberle DR, Demello S, Berg CD, et al. Results of the two incidence screenings in the national lung screening trial[J]. N Engl J Med,2013,369(10):920-931.
[19] Aberle DR, Berg CD, Black WC, et al. The national lung screening trial: overview and study design[J]. Radiology,2011,258(1):243-253.
[20] Kent M, Landreneau R, Mandrekar S, et al. Segmentectomy versus wedge resection for non-small cell lung cancer in high-risk operable patients[J]. Ann Thorac Surg,2013,96(5):1747-1754, 1754-1755.
[21] Nakao M, Yoshida J, Goto K, et al. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules[J]. J Thorac Oncol,2012,7(10):1563-1566.
[22] 董元焕, 孙蕾, 战忠利,等. 1138例肺部肿物术中冰冻诊断结果分析[J]. 中国肿瘤临床,2011,38(22):1403-1407.
[23] Marchevsky AM, Changsri C, Gupta I, et al. Frozen section diagnoses of small pulmonary nodules: accuracy and clinical implications[J]. Ann Thorac Surg,2004,78(5):1755-1759.
[24] Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections[J]. Mod Pathol,2015,28(8):1058-1063.
[25] Myung JK, Choe G, Chung DH, et al. A simple inflation method for frozen section diagnosis of minute precancerous lesions of the lung[J]. Lung Cancer,2008,59(2):198-202.
[26] Matsushima J, Yazawa T, Suzuki M, et al. Clinicopathological, immunohistochemical and mutational analyses of pulmonary enteric adenocarcinoma: usefulness of SATB2 and beta-catenin immunostaining for differentiation from metastatic colorectal carcinoma[J]. Hum Pathol,2017,64:179-185.
[27] Wang CX, Liu B, Wang YF, et al. Pulmonary enteric adenocarcinoma: a study of the clinicopathologic and molecular status of nine cases[J]. Int J Clin Exp Pathol,2014,7(3):1266-1274.