术中冰冻切片误诊为AAH/AIS/MIA的浸润性肺腺癌患者预后良好,Chest

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术中冰冻切片误诊为AAH/AIS/MIA的浸润性肺腺癌患者预后良好
Chest ( IF 9.5 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.chest.2020.10.076
Yang Zhang ₁ , Chaoqiang Deng ₁ , Fangqiu Fu ₁ , Zelin Ma ₁ , Zhexu Wen ₁ , Xiangyi Ma ₁ , Shengping Wang ₂ , Yuan Li ₃ , Haiquan Chen ₁

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背景我们之前的研究表明，术中冰冻切片（FS）可以准确区分浸润性肺腺癌（LUAD）和浸润前病变。然而，很少有文章分析 FS 错误的临床影响，例如低估侵袭性腺癌，以及是否需要补充治疗仍存在争议。研究问题本研究旨在调查因侵入性 LUAD 被误诊为非典型腺瘤样增生 (AAH)/原位腺癌 (AIS)/微创腺癌 (MIA) 的侵入性 LUAD 接受有限切除术患者的预后。研究设计与方法 2012-2018 年，收集 3031 例接受 FS 诊断的 AAH/AIS/MIA 亚肺叶切除患者的数据。评估了 FS 和最终病理 (FP) 之间的一致率。为了评估 FS/FP 差异的临床意义，确定了最终病理学中具有浸润性腺癌的患者进行预后评估。结果当AAH、AIS和MIA归为一组时，FS和FP的总体一致率为93.7%，192名（6.3%）患者从FP得到升级诊断。误诊的浸润性腺癌包括94例（48.9%）贴壁型腺癌、77例（40.1%）腺泡型腺癌、19例（9.9%）乳头状腺癌、1例实性型腺癌和1例浸润性腺癌。在这些患者中，未发现阳性N1、N2淋巴结。此外，即使最终病理结果为浸润性腺癌，5 年无复发生存率仍为 100%。解释 FS 误诊为 AAH/AIS/MIA 的侵入性 LUAD 有限切除的患者预后良好。对于这些被低估的侵入性 LUAD，由 FS 诊断指导的亚肺叶切除术就足够了。

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Excellent Prognosis of Patients with Invasive Lung Adenocarcinomas Intraoperatively Misdiagnosed as AAH/AIS/MIA by Frozen Section

BACKGROUND Our previous study revealed that intraoperative frozen section (FS) could accurately differentiate invasive lung adenocarcinoma (LUAD) from pre-invasive lesions. However, few articles analyzed the clinical impact of FS errors such as underestimation of invasive adenocarcinomas, and whether complementary therapy was needed remains controversial. RESEARCH QUESTION This study aims to investigate the prognosis of patients undergoing limited resection for invasive LUAD misdiagnosed as atypical adenomatous hyperplasia (AAH)/adenocarcinoma in situ (AIS)/minimally invasive adenocarcinoma (MIA) by intraoperative FS. STUDY DESIGN AND METHODS From 2012 to 2018, data on 3031 patients undergoing sublobar resection of AAH/AIS/MIA diagnosed by FS were collected. The concordance rate between FS and final pathology (FP) was evaluated. To assess the clinical significance of FS/FP discrepancy, patients with invasive adenocarcinomas in final pathology were identified for prognostic evaluation. RESULTS When AAH, AIS and MIA were classified together as a group, the overall concordance rate between FS and FP was 93.7%, and 192 (6.3%) patients got an upgraded diagnosis from the FP. Misdiagnosed invasive adenocarcinomas consisted of 94 (48.9%) lepidic predominant adenocarcinoma, 77 (40.1%) acinar predominant adenocarcinoma, 19 (9.9%) papillary predominant adenocarcinoma, one solid predominant pattern and one invasive mucinous adenocarcinoma. Among these patients, no positive N1, N2 lymph node was found. Moreover, the 5-year recurrence-free survival was still 100% even the final pathology turned out to be invasive adenocarcinoma. INTERPRETATION Patients undergoing limited resection of invasive LUAD misdiagnosed as AAH/AIS/MIA by FS had excellent prognosis. Sublobar resection guided by FS diagnosis would be adequate for these underestimated invasive LUAD.

更新日期：2020-11-01

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