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Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections.

I期肺腺癌术中冰冻切片IASLC/ATS/ERS病理组织学分型精确性研究

Trejo Bittar HE,Incharoen P,Althouse AD,Dacic S

Abstract

Histological subtyping of surgically resected lung adenocarcinoma has been shown to be of prognostic significance, and limited surgical resection has been proposed as a treatment of choice for early-stage lung adenocarcinoma. The accuracy of histological subtyping has been recently assessed in the surgical resection and small biopsy specimens; however, the accuracy of intraoperative subtyping on frozen sections remains relatively unknown. The aim of this study was to determine diagnostic accuracy and interobserver variability in histological subtyping of lung adenocarcinoma on intraoperative frozen sections. Overall, 112 consecutive cases of surgically resected stage I lung adenocarcinoma were reviewed independently by three pathologists. Histological patterns (acinar, lepidic, papillary, micropapillary, and solid) and mucinous variant were recorded in 5% increments for each intraoperative frozen and permanent sections. Primary and secondary histological patterns were assigned in each case. Kappa scores were calculated to evaluate agreement between pathologists in the assessment of histological subtype on intraoperative frozen sections versus permanent sections. Overall agreement between intraoperative frozen and permanent sections was moderate for primary pattern (69.7% of cases), with kappa scores ranging from 0.43 to 0.58, with more consistent agreement for stage IA tumors. Kappa scores for the secondary pattern ranged from 0.16 to 0.32. Acinar and solid patterns were most likely to be correctly identified as primary growth patterns. Micropapillary pattern was recognized in only 11-55% of cases. The main reasons for discrepancies between intraoperative frozen and permanent sections were inadequate sampling and poor quality of frozen sections. Our study suggests that it is difficult to predict the primary adenocarcinoma pattern on a single representative frozen section. This observation suggests a potential impact on the extent of frozen section sampling by pathologists at the time of intraoperative consultation, if surgical management of stage I lung adenocarcinoma will be guided by its histological subtype.

摘要

手术切除肺腺癌的组织学分型已被证实具有影响预后的重要意义,局限性手术切除被认为是早期肺腺癌的治疗方案。近年来小活检标本和手术切除标本病理组织学分型的准确性已有研究;然而,对术中冰冻切片病理组织学分型的准确性尚未见研究。

本研究的目的是明确肺腺癌术中冰冻切片病理组织学分型的准确性和诊断医师之间的差异。由三位病理医生独立重新复习了112例I期肺腺癌手术切除标本连续切片。按照5%增量记录每例术中冰冻切片和石蜡切片的组织学结构(腺泡状、贴壁样、乳头状、微乳头状和实体样)和黏液样亚型。每个病例重新评估主要和次要组织学结构。通过计算Kappa值评估病理医生对术中冰冻切片与石蜡切片组织学亚型诊断的一致性。

整体而言,术中冰冻切片和石蜡切片对主要组织学结构之间的诊断一致性是中度(69.7%病例),κ值从0.43至0.58,IA期肿瘤诊断的一致性更高。次要组织学改变κ值从0.16至0.32。腺泡状和实体型结构是最易准确识别的主要结构。仅有11-55%病例中可识别微乳头状结构。术中冰冻切片与石蜡切片诊断差异的主要原因是取材不充分和冰冻切片质量差。

我们的研究表明,仅从单一代表性冰冻切片诊断腺癌的主要结构是困难的。本研究提示,如果I期肺腺癌手术方式和范围由其组织学亚型主导,术中冰冻切片诊断时病理医师充分取样对其具有潜在影响。

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