Frozen Section Diagnosis Can Guide Resection in Early Lung Cancer

The use of intraoperative frozen section diagnosis correlated strongly with final pathology for peripheral small-sized lung adenocarcinoma in a new study. The ability to rule out an invasive adenocarcinoma could be an important step in helping guide surgical treatment decisions in these patients.

“Sublobar resection has the advantages of preserving lung function, better perioperative morbidity and mortality, and a chance for a second resection with a subsequent primary lung tumor,” wrote Haiquan Chen, MD, of Fudan University Shanghai Cancer Center in China, and colleagues. There is little evidence and no standards in place to determine who exactly is a candidate for sublobar resection.

The use of frozen section to rule out invasive adenocarcinoma could represent such a standard. In the study, researchers compared frozen section diagnosis with final pathology among 803 patients with clinical stage I peripheral lung adenocarcinoma. The frozen section diagnosis was divided into atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma. Results were published in the Journal of Clinical Oncology.

There were a total of 125 cases of discrepancy between frozen section and final pathology, for a total concordance rate of 84.4%. When the three lower-risk groups-AAH, AIS, and MIA-were classified together as one low-risk group, the concordance rate was 95.9%. Ninety-two of the 125 discrepancies (73.6%) were among AAH, AIS, and MIA.

In most cases of discrepancy (78.4%), the error in diagnosis had no influence on the clinical treatment of patients because the resulting resection was adequate. A total of seven patients (0.9%) were deemed to have undergone insufficient resection for their lesions.

“In conclusion, [frozen section] has a high concordance rate with [final pathology],” the authors wrote. “Precise diagnosis of intraoperative [frozen section] is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma.”

In an accompanying editorial, Jessica S. Donington, MD, of New York University School of Medicine in New York, wrote, “The ability to rule out the presence of invasive adenocarcinoma components on frozen section represents a significant step forward in appropriately directing the use of elective sublobar resection for early-stage adenocarcinoma of the lung.” She noted, though, that previous attempts at this method have yielded lower success rates than the current study, suggesting that perhaps it is only feasible at high-volume centers and academic institutions with highly specialized pathologists.

“These techniques may still be several years away from widespread use, but represent an important step toward personalization of surgical care for early-stage lung cancer,” she wrote.