Precise Diagnosis of Intraoperative Frozen Section Is an Effective Method to Guide Resection Strategy for Peripheral Small-Sized Lung Adenocarcinoma
PUBLISHED: 2016-02-17  1530 total views, 4 today

Shilei Liu1,5Rui Wang1,2Yang Zhang1,2,Yuan Li1,2Chao Cheng1,2Yunjian Pan1,2,Jiaqing Xiang1,2Yawei Zhang1,2Haiquan Chen1,3,4 and Yihua Sun1,2

1Fudan University Shanghai Cancer Center;

2Shanghai Medical College, Fudan University; 

3Shanghai Chest Hospital;

4Shanghai Jiao Tong University;

5The Affiliated Cancer Hospital of Zhengzhou University


Corresponding author: Haiquan Chen, MD, Department of Thoracic Surgery, Department of Oncology, Shanghai Medical College, Institutes of Biomedical Sciences, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China; e-mail: hqchen1@yahoo.com.

Abstract

Purpose This study investigated the accuracy of intraoperative frozen section (FS) diagnosis for predicting the final pathology (FP) of peripheral small-sized lung adenocarcinoma and evaluated its usefulness in sublobar resection.

Patients and Methods The records of 803 patients with clinical stage I peripheral lung adenocarcinoma who underwent sublobar resection for FS diagnosis to guide surgical strategy were reviewed. The surgical extension was mainly based on FS. The FS were stratified into atypical adenomatous hyperplasia, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma. The diagnostic accuracy of FS, the reasons for the discrepancy between FS and FP, and the clinical influence of the FS errors were evaluated. To assess the survival of patients with different subtypes after surgery, 301 patients were identified for prognosis evaluation.

Results The total concordance rate between FS and FP was 84.4%. When atypical adenomatous hyperplasia, AIS, and MIA were classified together as a low-risk group, the concordance rate was 95.9%. Most discrepant cases were the underestimation of AIS and MIA. The diagnostic accuracy of FS for tumors ≤ 1 cm and larger than 1 cm in diameter was 79.6% and 90.8%, respectively (P < .01). The FS errors had significant clinical impact on 0.9% of the 803 patients due to insufficient resection. The 5-year recurrence-free survival rate (100%) was significantly better for the patients with AIS/MIA than for patients with invasive adenocarcinoma (74.1%, P < .01).

Conclusion Frozen pathology has a high concordance rate with FP. Precise diagnosis by intraoperative FS is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma.

Disclaimer: Only abstract of articles from non-members were published. This page aims to promote Chinese scientific research. There is no conflicts of interest with any journals reserved the copyright. For more please contact the author.

Author
Dr. Chen Haiquan
+ Author Profile

Dr. Chen Haiquan  

Director of thoracic surgery and ICU in Fudan University Shanghai Cancer Center

Deputy Dean forbusiness of Fudan University Shanghai Cancer Center

 

Expertise: 

Early diagnosis of lung cancer and esophagus cancer.

Multidisciplinary treatment based more on minimally invasive surgery


Achievement:

He pioneered the clinical use of EBUS-TBNA, HookWirepositioning assisted thoracoscopic resection of solitary pulmonary nodules, Internationalearly lung cancer screening Action Plan (I-ELCAP), and Ivor Lewis esophagealcancer resection, etc. 

Was elected as AATS active member and became the only Chinese member of thissociety. 


Email: hqchen1@yahoo.com.

 


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