Analysis of intraoperative frozen section diagnosis of 1 263 pulmonary nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Xiang ¹ , LIANG Xiaolong ¹ , YOU Bin ² , CAO Qing ¹ , LIU Hongmiao ¹ , ZHAO Hongying ¹ ,  LI Xue ¹

1. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, P. R. China;
2. Department of Chest Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, P. R. China;

Corresponding?author：

LI Xue, Email: pecan08@sina.com

Keywords：

Pulmonary nodules; lung shadow; intraoperative frozen section diagnosis; postoperative paraffin section diagnosis; malignant pulmonary tumor

DOI：

10.7507/1007-4848.202207028

Video：

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Objective To explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. Methods The intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. Results According to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. Conclusion Intraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.

Citation： ZHOU Xiang, LIANG Xiaolong, YOU Bin, CAO Qing, LIU Hongmiao, ZHAO Hongying, LI Xue. Analysis of intraoperative frozen section diagnosis of 1 263 pulmonary nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 78-84. doi: 10.7507/1007-4848.202207028 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Shima T, Kinoshita T, Sasaki N, et al. Feasibility of intraoperative diagnosis of lung adenocarcinoma in situ to avoid excessive resection. J Thorac Dis, 2021, 13(3): 1338-1346.
3.	陳金平, 周新成, 殷憲剛. 肺原發性良性黏液上皮性病變冷凍切片誤診為黏液腺癌12例分析. 臨床與實驗病理學雜志, 2019, 35(6): 705-706, 710.
4.	姜格寧, 陳昶, 朱余明, 等. 上海市肺科醫院磨玻璃結節早期肺腺癌的診療共識(第一版). 中國肺癌雜志, 2018, 21(3): 147-159.
5.	NCCN Clinical Practice Guidelines Oncology. Non-small cell lung cancer. Version 1.2020. URL: https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients. Accessed on 2022-06-30.
6.	Susan CL, edit. Diagnostic Pathology: Intraoperative Consultation. Second edition. Elsevier, 2019. 240-246.
7.	蔣漢文, 陳水蓮, 張小鷹, 等. 甲狀腺轉錄因子1免疫組織化學聯合彈力纖維雙重染色在肺腺癌診斷中的應用. 中華病理學雜志, 2021, 50(5): 514-517.
8.	謝惠康, 查俊彥, 趙力瀾, 等. 彈力纖維在肺腺泡型及乳頭型為主腺癌中的表達及其與患者預后的相關性. 中華病理學雜志, 2016, 45(6): 375-380.
9.	Travis WD, Brambilla E, Burke AP, et al. WHO classification of tumours of the lung, pleura, thymus and heart. https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours. Accessed on 2022-06-30.
10.	WHO Classification of Tumours Editorial Board. WHO classification of tumours: Thoracic tumours. 5^th Edition. https://publications.iarc.fr/595. Accessed on 2022-06-30.
11.	Borczuk AC. Challenges of frozen section in thoracic pathology: Lepidic lesions, limited resections, and margins. Arch Pathol Lab Med. 2016.141(7): 932-939.
12.	He P, Yao G, Guan Y, et al. Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: An analysis of 136 cases. J Clin Pathol, 2016, 69(12): 1076-1080.
13.	Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
14.	Luis HA, Zhou Y, Sihoe AD, et al. Survival is not compromised in patients with invasive adenocarcinoma found in GGOs receiving sublobar resection due to intraoperative frozen section ambiguity: A prospensity score matched analysis. 25th European Conference on General Thoracic Surgery, 2017.
15.	Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
16.	劉彤華. 診斷病理學今后應怎樣發展. 診斷病理學雜志, 2003, 10(4): 193-194.
17.	Butnor KJ. Avoiding underdiagnosis, overdiagnosis, and misdiagnosis of lung carcinoma. Arch Pathol Lab Med, 2008, 132(7): 1118-1132.
18.	Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stageⅠlung adenocarcinoma on intraoperative frozen sections. Mod Pathol, 2015, 28(8): 1058-1063.
19.	Chang JC, Montecalvo J, Borsu L, et al. Bronchiolar adenoma: Expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 cases. Am J Surg Pathol, 2018, 42(8): 1010-1026.
20.	Ishikawa Y. Ciliated muconodular papillary tumor of the peripheral lung: Benign or malignant? Pathol Clin Med (Byouri-to-Rinsho), 2002, 20: 964-965.
21.	王恩華. 細支氣管腺瘤: 易與癌混淆的良性腫瘤. 中華病理學雜志, 2019, 48(6): 425-432.
22.	高何, 杜曉劉, 陳春妮, 等. 細支氣管腺瘤15例臨床病理學觀察. 中華病理學雜志, 2020, 49(6): 556-561.
23.	甘詠莉, 葛榮. 術中冰凍切片診斷肺部腫物427例分析. 實用腫瘤雜志, 2013, 28(3): 306-308.
24.	Yang CH, Lee LY. Pulmonary sclerosing pneumocytoma remains a diagnostic challenge using frozen sections: A clinicopathological analysis of 59 cases. Histopathology, 2018, 72(3): 500-508.
25.	沈元龍, 李琳, 吳子豪. 術中冰凍切片快速免疫組化HE染色技術診斷硬化性肺細胞瘤和肺腺癌的應用對比. 安徽醫學, 2019, 40(12): 1392-1395.
26.	劉加夫, 侯立坤, 武春燕. 肺硬化性血管瘤120例臨床病理分析. 臨床與實驗病理學雜志, 2015, 31(2): 174-177.
27.	韓國敬, 胡紅, 毛丹, 等. IgG4相關性肺疾病八例臨床特征分析. 中華結核和呼吸雜志, 2017, 40(3): 193-198.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Shima T, Kinoshita T, Sasaki N, et al. Feasibility of intraoperative diagnosis of lung adenocarcinoma in situ to avoid excessive resection. J Thorac Dis, 2021, 13(3): 1338-1346.
3. 陳金平, 周新成, 殷憲剛. 肺原發性良性黏液上皮性病變冷凍切片誤診為黏液腺癌12例分析. 臨床與實驗病理學雜志, 2019, 35(6): 705-706, 710.
4. 姜格寧, 陳昶, 朱余明, 等. 上海市肺科醫院磨玻璃結節早期肺腺癌的診療共識(第一版). 中國肺癌雜志, 2018, 21(3): 147-159.
5. NCCN Clinical Practice Guidelines Oncology. Non-small cell lung cancer. Version 1.2020. URL: https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients. Accessed on 2022-06-30.
6. Susan CL, edit. Diagnostic Pathology: Intraoperative Consultation. Second edition. Elsevier, 2019. 240-246.
7. 蔣漢文, 陳水蓮, 張小鷹, 等. 甲狀腺轉錄因子1免疫組織化學聯合彈力纖維雙重染色在肺腺癌診斷中的應用. 中華病理學雜志, 2021, 50(5): 514-517.
8. 謝惠康, 查俊彥, 趙力瀾, 等. 彈力纖維在肺腺泡型及乳頭型為主腺癌中的表達及其與患者預后的相關性. 中華病理學雜志, 2016, 45(6): 375-380.
9. Travis WD, Brambilla E, Burke AP, et al. WHO classification of tumours of the lung, pleura, thymus and heart. https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours. Accessed on 2022-06-30.
10. WHO Classification of Tumours Editorial Board. WHO classification of tumours: Thoracic tumours. 5^th Edition. https://publications.iarc.fr/595. Accessed on 2022-06-30.
11. Borczuk AC. Challenges of frozen section in thoracic pathology: Lepidic lesions, limited resections, and margins. Arch Pathol Lab Med. 2016.141(7): 932-939.
12. He P, Yao G, Guan Y, et al. Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: An analysis of 136 cases. J Clin Pathol, 2016, 69(12): 1076-1080.
13. Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
14. Luis HA, Zhou Y, Sihoe AD, et al. Survival is not compromised in patients with invasive adenocarcinoma found in GGOs receiving sublobar resection due to intraoperative frozen section ambiguity: A prospensity score matched analysis. 25th European Conference on General Thoracic Surgery, 2017.
15. Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
16. 劉彤華. 診斷病理學今后應怎樣發展. 診斷病理學雜志, 2003, 10(4): 193-194.
17. Butnor KJ. Avoiding underdiagnosis, overdiagnosis, and misdiagnosis of lung carcinoma. Arch Pathol Lab Med, 2008, 132(7): 1118-1132.
18. Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stageⅠlung adenocarcinoma on intraoperative frozen sections. Mod Pathol, 2015, 28(8): 1058-1063.
19. Chang JC, Montecalvo J, Borsu L, et al. Bronchiolar adenoma: Expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 cases. Am J Surg Pathol, 2018, 42(8): 1010-1026.
20. Ishikawa Y. Ciliated muconodular papillary tumor of the peripheral lung: Benign or malignant? Pathol Clin Med (Byouri-to-Rinsho), 2002, 20: 964-965.
21. 王恩華. 細支氣管腺瘤: 易與癌混淆的良性腫瘤. 中華病理學雜志, 2019, 48(6): 425-432.
22. 高何, 杜曉劉, 陳春妮, 等. 細支氣管腺瘤15例臨床病理學觀察. 中華病理學雜志, 2020, 49(6): 556-561.
23. 甘詠莉, 葛榮. 術中冰凍切片診斷肺部腫物427例分析. 實用腫瘤雜志, 2013, 28(3): 306-308.
24. Yang CH, Lee LY. Pulmonary sclerosing pneumocytoma remains a diagnostic challenge using frozen sections: A clinicopathological analysis of 59 cases. Histopathology, 2018, 72(3): 500-508.
25. 沈元龍, 李琳, 吳子豪. 術中冰凍切片快速免疫組化HE染色技術診斷硬化性肺細胞瘤和肺腺癌的應用對比. 安徽醫學, 2019, 40(12): 1392-1395.
26. 劉加夫, 侯立坤, 武春燕. 肺硬化性血管瘤120例臨床病理分析. 臨床與實驗病理學雜志, 2015, 31(2): 174-177.
27. 韓國敬, 胡紅, 毛丹, 等. IgG4相關性肺疾病八例臨床特征分析. 中華結核和呼吸雜志, 2017, 40(3): 193-198.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of intraoperative frozen section diagnosis of 1 263 pulmonary nodules

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