An effective inflation treatment for frozen section diagnosis of small-sized lesions of the lung

Abstract

Background: The accuracy of intraoperative pathological diagnosis of small-sized pulmonary nodules including ground-glass opacity (GGO) is important for the surgeon to choose a suitable surgical procedure. Diagnosis of the small-sized lesions of the lung by frozen section (FS) is very difficult for the pathologist because of limited FS technology. Here we tested an effective inflation treatment for FS to improve the diagnostic accuracy of small-sized lung lesions.

Methods: The lung specimens were derived from 113 patients who underwent the surgery at Shanghai Chest Hospital in 2018-2019. The specimens were randomly divided into two groups-uninflated or inflated with diluted embedding medium (Tissue-Tek OCT; Sakura Finetek-USA, CA). The qualities of the FSs were compared with that of corresponding permanent paraffin sections. The FS diagnoses were compared with the final pathologic diagnoses of corresponding permanent sections.

Results: Our results showed that the quality of FS of lung tissue was excellent after inflation with diluted embedding medium (1:1). The total consistency between diagnosis of inflated FS and final pathological diagnosis was 85.7%. In control group, however, the consistency was only 70.2%. When the lesions were less than 1cm, the consistency between diagnosis of inflated FS and final pathological diagnosis was 90.3%, compared to 64.9% consistency in uninflated group (P=0.014, <0.05). When the lesions' computed tomography (CT) measurement threshold ≤-350 HU, the consistency between diagnosis of inflated FS and final pathological diagnosis was 88% compared to 73.2% consistency in uninflated group (P=0.071, >0.05). Accuracy, sensitivity and specificity were observed about 90% for adenocarcinoma in situ (AIS), whereas it is drop to more than 80% for minimally invasive adenocarcinoma (MIA) in inflated FS.

Conclusions: Inflation with diluted embedding medium (1:1) could make lung tissue expand well during FS. By using this method, small-sized lesions (especially less than 1 cm) could be correctly diagnosed to enable adequate surgical procedure, and evaluation of which can be easily based on the intraoperative pathological diagnosis. The small lesions especially AIS could be readily identified on FS. Therefore, this method improves the diagnostic accuracy of FSs for small-sized lung lesions, and has important practical consequences for further therapy.

Keywords: Lung cancer; frozen section diagnosis; ground-glass opacity (GGO); inflation.

Figure 1

The frozen section, H&E and CT of the two groups in this study. Original magnifications: left 40×; right 100×. (A) Frozen section of AIS when inflated with diluted embedding medium. Final pathology (B, H&E) and CT (C) in this case. (D) Frozen section of MIA when inflated with diluted embedding medium. Final pathology (E, H&E) and CT (F) in this case. (G) Frozen section of IA when inflated with diluted embedding medium. Final pathology (B, H&E) and CT (C) in this case. (J) Frozen section of AIS in the control group. Final pathology (K, H&E) and CT (L) in this case. (M) Frozen section of MIA in the control group. Final pathology (N, H&E) and CT (O) in this case. (P) Frozen section of IA in the control group. Final pathology (Q, H&E) and CT (R) in this case. CT, computed tomography; AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma; IA, invasive adenocarcinoma.