OBJECTIVE To investigate the value of intraoperative assessment of spread through air spaces (STAS) on frozen sections (FS) in peripheral small-sized lung adenocarcinoma. BACKGROUND Surgical decision-making based on FS diagnosis of STAS may be useful to prevent local control failure after sublobar resection. METHODS We conducted a multicenter prospective observational study of consecutive patients with cT1N0M0 invasive lung adenocarcinoma to evaluate the accuracy of FS for the intraoperative detection of STAS. The final pathology (FP) diagnosis of STAS was based on corresponding permanent paraffin sections. RESULTS This study included 878 patients with cT1N0M0 invasive lung adenocarcinoma. A total of 833 cases (95%) were assessable for STAS on FS. 26.4% of the cases evaluated positive for STAS on FP, whereas 18.2% on FS. The accuracy, sensitivity, and specificity of FS diagnosis of STAS were 85.1%, 56.4%, and 95.4%, respectively, with moderate agreement (κ=0.575). Inter-observer agreement was substantial (κ=0.756) among the three pathologists. Subgroup analysis based on tumor size or consolidation-to-tumor ratio all showed moderate agreement for concordance. After rigorous reassessment of false-positive cases, the presence of artifacts may be the main cause of interpretation errors. Additionally, true positive cases showed more high-grade histological patterns and more advanced p-TNM stages than false negative cases. CONCLUSIONS This is the largest prospective observational study to evaluate STAS on FS in patients with cT1N0M0 invasive lung adenocarcinoma. FS is highly specific with moderate agreement, but is not sensitive for STAS detection. While appropriately reporting STAS on FS may provide surgeons with valuable information for intraoperative decision-making, better approaches are needed.

中文翻译：

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通过术中冰冻切片预测 cT1N0M0 侵袭性肺腺癌患者的空气空间传播 (STAS)：一项多中心观察性研究 (ECTOP-1016)。


目的探讨术中评估周围型小尺寸肺腺癌冰冻切片（FS）气隙扩散（STAS）的价值。背景 基于 FS 诊断 STAS 的手术决策可能有助于防止亚肺叶切除术后局部控制失败。方法 我们对连续的 cT1N0M0 浸润性肺腺癌患者进行了一项多中心前瞻性观察研究，以评估 FS 术中检测 STAS 的准确性。 STAS 的最终病理学 (FP) 诊断基于相应的永久石蜡切片。结果 本研究纳入了 878 名 cT1N0M0 浸润性肺腺癌患者。共有 833 例 (95%) 患者可在 FS 上进行 STAS 评估。 26.4% 的病例在 FP 上评估为 STAS 阳性，而在 FS 上评估为 18.2%。 FS诊断STAS的准确性、敏感性和特异性分别为85.1%、56.4%和95.4%，具有中等一致性（κ=0.575）。三位病理学家之间的观察者间一致性很高（κ=0.756）。基于肿瘤大小或实变与肿瘤比率的亚组分析均显示出中等程度的一致性。对假阳性病例进行严格的重新评估后，伪影的存在可能是解释错误的主要原因。此外，与假阴性病例相比，真阳性病例显示出更高级别的组织学模式和更先进的 p-TNM 分期。结论 这是评估 STAS 对 cT1N0M0 侵袭性肺腺癌患者 FS 影响的最大规模前瞻性观察性研究。 FS 具有高度特异性和中等一致性，但对 STAS 检测不敏感。 虽然适当报告 FS 上的 STAS 可以为外科医生提供术中决策的宝贵信息，但仍需要更好的方法。