Excellent Prognosis of Patients With Invasive Lung Adenocarcinomas During Surgery Misdiagnosed as Atypical Adenomatous Hyperplasia, Adenocarcinoma In Situ, or Minimally Invasive Adenocarcinoma by Frozen Section

Yang Zhang; Chaoqiang Deng; Fangqiu Fu; Zelin Ma; Zhexu Wen; Xiangyi Ma; Shengping Wang; Yuan Li; Haiquan Chen

doi:10.1016/j.chest.2020.10.076

Excellent Prognosis of Patients With Invasive Lung Adenocarcinomas During Surgery Misdiagnosed as Atypical Adenomatous Hyperplasia, Adenocarcinoma In Situ, or Minimally Invasive Adenocarcinoma by Frozen Section

Chest. 2021 Mar;159(3):1265-1272. doi: 10.1016/j.chest.2020.10.076. Epub 2020 Nov 14.

Authors

Yang Zhang¹, Chaoqiang Deng¹, Fangqiu Fu¹, Zelin Ma¹, Zhexu Wen¹, Xiangyi Ma¹, Shengping Wang², Yuan Li³, Haiquan Chen⁴

Affiliations

¹ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
² Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China.
³ Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China.
⁴ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: hqchen1@yahoo.com.

PMID: 33197404
DOI: 10.1016/j.chest.2020.10.076

Abstract

Background: Our previous study revealed that intraoperative frozen section (FS) analysis could differentiate invasive lung adenocarcinoma (LUAD) accurately from preinvasive lesions. However, few articles have analyzed the clinical impact of FS errors such as underestimation of invasive adenocarcinomas (IACs), and whether complementary therapy is needed remains controversial.

Research question: What is the prognosis of patients undergoing limited resection for invasive LUAD misdiagnosed as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), or minimally invasive adenocarcinoma (MIA) by intraoperative FS analysis?

Study design and methods: From 2012 through 2018, data on 3031 patients undergoing sublobar resection of AAH, AIS, or MIA diagnosed by FS analysis were collected. The concordance rate between FS analysis and final pathologic results was evaluated. To assess the clinical significance of a discrepancy between FS and final pathologic results, patients with final pathologic results of IAC were identified for prognostic evaluation.

Results: When AAH, AIS, and MIA were classified together as a group, the overall concordance rate between FS and final pathologic results was 93.7%, and 192 patients (6.3%) received an upgraded diagnosis from the final pathologic results. Misdiagnosed IACs consisted of 94 patients (48.9%) with lepidic-predominant adenocarcinoma, 77 patients (40.1%) with acinar predominant adenocarcinoma, 19 patients (9.9%) with papillary predominant adenocarcinoma, one patient with solid predominant adenocarcinoma, and one patient with invasive mucinous adenocarcinoma. Among these patients, no positive N1 or N2 lymph node findings were observed. Moreover, the 5-year recurrence-free survival was still 100%, although the final pathologic results turned out to be IAC.

Interpretation: Patients undergoing limited resection of invasive LUAD misdiagnosed as AAH, AIS, or MIA by FS analysis showed excellent prognoses. Sublobar resection guided by FS diagnosis would be adequate for these underestimated cases of invasive LUAD.

Keywords: frozen section; prognosis; sublobar resection; upgrade.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma in Situ / diagnosis
Adenocarcinoma of Lung* / diagnosis
Adenocarcinoma of Lung* / pathology
Adenocarcinoma of Lung* / surgery
Adenomatosis, Pulmonary / diagnosis
China / epidemiology
Diagnostic Errors / statistics & numerical data
Female
Frozen Sections / methods*
Humans
Intraoperative Care / methods*
Lung Neoplasms* / diagnosis
Lung Neoplasms* / pathology
Lung Neoplasms* / surgery
Male
Middle Aged
Neoplasm Invasiveness
Pneumonectomy* / methods
Pneumonectomy* / statistics & numerical data
Precancerous Conditions / diagnosis*
Prognosis
Tomography, X-Ray Computed / methods