Sub-lobar resection versus lobectomy for challenging intraoperative frozen sections in lung adenocarcinoma within 3 cm

Junguo Dong; Yongjiang Chen; Weiping Qian; Zhenzhen He; Ping He; Lili Mo; Yidong Wang; Wei Wang; Hengrui Liang; Jianxing He

doi:10.1016/j.asjsur.2024.05.002

Sub-lobar resection versus lobectomy for challenging intraoperative frozen sections in lung adenocarcinoma within 3 cm

Asian J Surg. 2024 May 17:S1015-9584(24)00890-X. doi: 10.1016/j.asjsur.2024.05.002. Online ahead of print.

Authors

Junguo Dong¹, Yongjiang Chen¹, Weiping Qian², Zhenzhen He³, Ping He³, Lili Mo¹, Yidong Wang¹, Wei Wang¹, Hengrui Liang⁴, Jianxing He⁵

Affiliations

¹ Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.
² Department of Respiratory and Critical Care Medicine, Dongguan People's Hospital, Dongguan, Guangdong, China.
³ Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
⁴ Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China. Electronic address: hengrui_liang@163.com.
⁵ Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China. Electronic address: drjianxing.he@gmail.com.

PMID: 38760222
DOI: 10.1016/j.asjsur.2024.05.002

Abstract

Objectives: Intraoperative frozen section (FS) analysis is pivotal in guiding surgical interventions for early-stage lung adenocarcinoma. However, the challenge arises when distinguishing between Minimally Invasive Adenocarcinoma (MIA) and Invasive Adenocarcinoma (IAC) poses diagnostic difficulties. This study investigates the prognosis and clinicopathological characteristics of patients encountering this diagnostic challenge.

Methods: We conducted a retrospective analysis of 7082 intraoperative FSs from early-stage lung adenocarcinoma cases. The cases with pulmonary nodules within 3 cm and diagnosed as indeterminate FSs were included. We analyzed baseline data, computed tomography (CT) findings, and pathological characteristics. Prognostic data were obtained from patients with confirmed IAC diagnoses through final pathological examination.

Results: Out of 7082 FSs, 551 cases presented challenges in distinguishing between MIA and IAC. Upon final pathological examination, 233 cases were identified as IAC, while 314 were classified as MIA. The median invasive pathological size in the IAC group was larger than that in the MIA group (0.6 cm vs 0.3 cm). 131 cases (56.2 %) with IAC underwent lobectomy, while 102 cases (43.8 %) underwent sub-lobar resection. Among the MIA cases, 220 cases (69.8 %) underwent sub-lobar resection, while 95 cases (30.2 %) underwent lobectomy. No recurrence and disease specific death was observed during the follow-up period, regardless of surgical strategy.

Conclusions: Indeterminate intraoperative FSs, posing diagnostic challenges in distinguishing between MIA and IAC. Sub-lobar resection presented the same long term survival benefit compared with the lobectomy for indeterminate lung adenocarcinoma within 3 cm during intraoperative FSs.

Keywords: Indeterminate frozen section; Lobectomy; NSCLC; Sub-lobar resection.