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Diagnosis of the Novel IASLC Grading System Using Intraoperative Frozen Section (ECTOP-1014): A Prospective,
Fangqiu Fu1, Yan Jin2, Chaoqiang Deng1
1Department of Thoracic Surgery and State Key Laboratory of Genetics and Development of Complex Phenotypes, 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.
Intraoperative frozen section shows good accuracy for diagnosing International Association for the Study of Lung Cancer (IASLC) grades in early-stage lung adenocarcinoma. However, lepidic and micropapillary patterns may increase misdiagnosis risk.
Area of Science:
- Thoracic Oncology
- Surgical Pathology
- Cancer Grading Systems
Background:
- The International Association for the Study of Lung Cancer (IASLC) introduced a new grading system for invasive non-mucinous adenocarcinoma.
- Accurate grading is crucial for guiding treatment decisions in early-stage lung adenocarcinoma.
Purpose of the Study:
- To assess the accuracy of intraoperative frozen section in diagnosing IASLC grades for early-stage lung adenocarcinoma.
- To identify factors contributing to potential misdiagnosis during frozen section analysis.
Main Methods:
- A prospective, multi-center clinical trial (ECTOP-1014) involving 131 patients.
- Comparison of frozen section diagnoses with final pathology reports.
- Logistic regression analysis to determine predictors of misdiagnosis.
Main Results:
- Overall concordance between frozen section and final pathology was 79.9% (κ = 0.627), indicating good agreement.
- Lepidic and micropapillary predominant patterns were significantly associated with higher misdiagnosis rates (P < 0.001).
- Interobserver agreement among pathologists was very good (κ = 0.821).
Conclusions:
- Frozen section provides reliable precision for IASLC grading and can assist surgical decision-making in lung adenocarcinoma.
- Specific histological patterns, namely lepidic and micropapillary, present challenges and may increase misdiagnosis rates.
- Further research is needed to confirm these findings and evaluate the clinical impact of frozen section-guided surgical choices.
