冰冻切片准确预测具有侵袭性肺腺癌的病患在IASLC建议的分级体系和预后中的表现。
Frozen sections accurately predict the IASLC proposed grading system and prognosis in patients with invasive lung adenocarcinomas.
发表日期：2023 Feb 17
作者：
Junqiang Fan, Jie Yao, Haojie Si, Huikang Xie, Tengfei Ge, Wei Ye, Jianle Chen, Zhongbo Yin, Fenghui Zhuang, Long Xu, Hang Su, Shengnan Zhao, Xiaofeng Xie, Deping Zhao, Chunyan Wu, Yuming Zhu, Yijiu Ren, Ning Xu, Chang Chen,
来源：
LUNG CANCER
摘要：
国际肺癌研究协会（IASLC）提出的肺腺癌（ADC）新评分系统已被证明具有预后意义。因此，在手术决策中，对评分系统的术中咨询非常重要。在此，我们评估了IASLC评分系统在冰冻切片上的准确性和观察者一致性，并进一步研究了其预后表现。在2013年1月至6月期间（回顾性队列），我们回顾了373例I期肺ADC手术切除后的肿瘤分级的冰冻切片和最终病理切片。招募了一个前瞻性多中心队列（2021年1月至6月，n = 212），以确认结果。
回顾性队列和前瞻性队列的FS和最终病理（FP）幻灯片由三名病理学家进行肿瘤分级的审查。总体一致率分别为79.1％（κ = 0.650）和89.6％（κ = 0.729），其中前瞻性队列的协议一致性更高。存在复杂腺管是FS和FP之间不一致的唯一独立预测因子（存在与不存在：奥斯比比0.015，2.193）。三名病理学家的IASLC评分系统在FS上的观察者一致性良好（κ = 0.672，回顾性队列; κ = 0.752，前瞻性队列）。此外，通过FS诊断的IASLC评分系统可以很好地预测I期浸润性肺ADC患者的无复发生存和总生存率。
我们的结果表明，FS具有高诊断准确性和令人满意的IASLC评分系统观察者一致性。未来的前瞻性研究将证实使用FS将患者匹配到适当的手术类型的可行性。版权所有©2023 Elsevier B.V.。保留所有权利。
The International Association for the Study of Lung Cancer (IASLC) newly proposed grading system for lung adenocarcinomas (ADC) has been shown to be of prognostic significance. Hence, intraoperative consultation for the grading system was important regarding the surgical decision-making. Here, we evaluated the accuracy and interobserver agreement for IASLC grading system on frozen section (FS), and further investigated the prognostic performance.FS and final pathology (FP) slides were reviewed by three pathologists for tumor grading in 373 stage I lung ADC following surgical resection from January to June 2013 (retrospective cohort). A prospective multicenter cohort (January to June 2021, n = 212) were included to confirm the results.The overall concordance rates between FS and FP were 79.1% (κ = 0.650) and 89.6% (κ = 0.729) with substantial agreement in retrospective and prospective cohorts, respectively. Presence of complex gland was the only independent predictor of discrepancy between FS and FP (presence versus. absence: odds ratio, 2.193; P = 0.015). The interobserver agreement for IASLC grading system on FS among three pathologists were satisfactory (κ = 0.672 for retrospective cohort; κ = 0.752 for prospective cohort). Moreover, the IASLC grading system by FS diagnosis could well predict recurrence-free survival and overall survival for patients with stage I invasive lung ADC.Our results suggest that FS had high diagnostic accuracy and satisfactory interobserver agreement for IASLC grading system. Future prospective studies are merited to validate the feasibility of using FS to match patients into appropriate surgical type.Copyright © 2023 Elsevier B.V. All rights reserved.