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. 2024 Mar 1:25:170-176.
doi: 10.1016/j.xjtc.2024.02.014. eCollection 2024 Jun.

Improving intraoperative diagnosis of spread through air spaces: A cryo-embedding-medium inflation method for frozen section analysis

Takashi Eguchi  1 , Shunichiro Matsuoka  1 , Mai Iwaya  2 , Shota Kobayashi  2 , Maho Seshimoto  1 , Shuji Mishima  1 , Daisuke Hara  1 , Hirotaka Kumeda  1 , Kentaro Miura  1 , Kazutoshi Hamanaka  1 , Takeshi Uehara  2 , Kimihiro Shimizu  1
Affiliations

Improving intraoperative diagnosis of spread through air spaces: A cryo-embedding-medium inflation method for frozen section analysis

Takashi Eguchi et al. JTCVS Tech. .

Abstract

Objective: Accurate intraoperative diagnosis of spread through air spaces (STAS), a known poor prognostic factor in lung cancer, is crucial for guiding surgical decision-making during sublobar resections. This study aimed to evaluate the diagnostic sensitivity of STAS using frozen section (FS) slides prepared with the cryo-embedding medium inflation technique.

Methods: In this prospective study at Shinshu University Hospital, 99 patients undergoing lung resection for tumors <3 cm in size were included, a total of 114 lesions. FS slides were prepared with injecting diluted cryo-embedding medium into the lung parenchyma of resected specimens. The diagnostic performance of these FS slides for STAS detection was evaluated by comparing FS-STAS results with the gold-standard STAS status.

Results: The incidence of STAS, determined by the gold standard, was 43 (38%) of 114 lesions, including 31 (37%) of 84 primary lung cancers and 12 (40%) of 30 metastatic lung tumors. The sensitivity, specificity, positive and negative predictive values, and accuracy of FS slides for STAS detection were 81%, 89%, 81%, 89%, and 86%, respectively. Specifically, in primary lung cancers, these values were 90%, 89%, 82%, 94%, and 89%, respectively. Regarding metastatic lung tumors, the corresponding values were 58%, 89%, 78%, 76%, and 77%, respectively.

Conclusions: Our adapted cryo-embedding medium inflation method has demonstrated enhanced sensitivity in detecting STAS on FS slides, providing results similar to the gold-standard STAS detection. Compared with historical benchmarks, this technique could show excellent performance and be readily incorporated into clinical practice without requiring additional resources beyond those used for standard FS analysis.

Keywords: cryo-embedding; intraoperative decision-making; lung cancer; spread through air spaces lesions.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Frozen section slide preparation process to detect tumor spread through air spaces (STAS).
Figure 1
Figure 1
Patient selection flowchart. FS, Frozen section.
Figure 2
Figure 2
A schematic representation of the frozen section slide-preparation process. STAS, Spread through air spaces.
Figure 3
Figure 3
Hematoxylin–eosin staining images of frozen section and permanent slides from representative cases. A, A frozen section slide from a patient with primary lung adenocarcinoma. B, A permanent slide from a patient with primary lung adenocarcinoma C, A frozen section slide from a patient with metastatic lung tumor (colon primary) D, A permanent slide from a patient with metastatic lung tumor (colon primary). Dotted lines and gray arrows represent tumor edge and STAS areas, respectively. STAS, Spread through air spaces.
See this image and copyright information in PMC

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