Accuracy and Reproducibility of Intraoperative Assessment on Tumor Spread Through Air Spaces in Stage 1 Lung Adenocarcinomas

Journal of Thoracic Oncology (2020-12) IF = 13.357
好久没水过来水一水，玩玩新图床

Introduction

这儿就是比较老生常谈的内容就没写啥

Material and Methods

Study Population

• resection for lung adenocarcinoma between January 1, 2010, and December 31, 2015
• Inclusion criteria:
  • FS of the main tumor was obtained for intraoperative consultation;
  • all FS, FSP, and NFP slides were available for review;
    • FS: frozen section
    • FSP: a formalin-fixed, paraffinembedded section corresponding to the FS
    • NFP: a formalin-fixed, paraffin-embedded section that had not been processed in FS
  • tumor slides (including FS, FSP, and NFP sections) had adequate adjacent non-neoplastic lung parenchyma for STAS evaluation
    • lung parenchyma surrounding at least one-third of the entire circumference of the tumor with ample non-neoplastic parenchyma between the tumor edge and the tissue edge.

主要是要有术中快速病理，然后要有对应的术后病理（个人觉得只要有FSP大概率就会有NFP吧）；另一方面，片子上要有足够多的边界用于评估。

Reference Diagnoses

The histologic slides of each case were evaluated by a panel of three pathologists. --- Record STAS and artifactual clusters

这篇文章STAS的标注是，先让三个高年资病理科医生进行读片，然后基于一个标准来诊断STAS

• STAS:（这儿STAS用的经典定义，微乳头簇，实性巢和单个肿瘤细胞）
  • tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor and comprised any of three morphologic patterns: micropapillary structures, solid nests, or single cells.
• Artifactual clusters:（这儿定义了一下人工伪影，我觉得有一定的意义，但是后面结果太烂了，就没细看）
  • clusters of cells randomly scattered over the tissue or at the edges of the tissue section clusters of cells with jagged edges suggestive of tumor fragmentation or edges of a knife cut during specimen processing;
  • linear strips of cells that were lifted off of alveolar walls;
  • isolated group(s) of tumor cells distant from the main tumor without a continuum of air spaces containing intra-alveolar tumor cells back to the tumor edge

Pathologist Observers

这儿找了五个人来看，看两轮，中间间隔一个半月，然后有三种，分别是“有STAS”、“没有STAS”以及“模棱两可的”

下面是一个我自己画的图图

阅片流程

image

• A中间的STAS在B中被确定为微乳头灶
• C中间不规则的肿瘤簇，在D图中被确认为伪影

image

• E图坐车右边看上去像微乳头或者实性巢，左侧的有很多锯齿状，看上去像伪影，这种就是模糊的。F图证明这个是STAS，但同时也揭示这种模棱两个的STAS可能是STAS和伪影的混合

• G图的伪影在H图上证明是STAS

Results

STAS Diagnosis

就是看看阳性阴性之间的区别吧

image-20210507220345371

• There was a high variability in the prevalence of STAS in FS, FSP, and NFP slides reported by all observers in both the first round and the second round:
  • R1 (range, FS: 20%–44%; FSP: 23%–48%; NFP: 33%–60%)
  • R2 (range, FS: 28%–41%; FSP: 22%–46%; NFP: 35%–58%)
• The identification of artifact in FS, FSP, and NFP slides was also variable in round 1 and round 2
  • R1 (FS: 40%– 68%; FSP: 54%–77%; NFP: 29%–62%)
  • R2 (FS: 27%–79%; FSP: 47%–74%; NFP: 30%–58%)
• In R1, two or more observers categorized 16%, 19%, and 16% of the cases as equivocal-STAS in FS, FSP, and NFP slides, respectively.
• In R2, 36%, 34%, and 21% of the cases were categorized as equivocal-STAS in FS, FSP, and NFP slides, respectively.

大概意思就是在诊断STAS的过程中，病理医生个体间差异极大，并且经过沟通之后，不确定性增加了？

Accuracy of Intraoperative STAS Diagnosis

Overall, most FS slides would be correctly classified.

• Accuracy 71% (95% CI: 61.1%–79.6%);

• ROC area under the curve (AUC) of 0.67 (95% CI: 0.56–0.78)

image-20210507221843592

The performance of FS across five pathologists

• The first round: (B)
  • Sensitivity: 35% to 77%
  • Specificity: 77% to 91%
  • AUC: 0.63 to 0.80
• The second round: (C)
  • Sensitivity: 54% to 70%
  • Specificity: 81% to 91%
  • AUC: 0.71 to 0.74

image-20210507221956716

下面有点写不下去了，回头来补充一下解读吧

IOA (interobserver agreement) on STAS Diagnoses

Intraobserver data were assessed for each pathologist on the basis of R1 and R2 interpretations of the same cases in FS, FSP, and NFP slides.

image-20210507223123403

IOA (interobserver agreement) on STAS Diagnoses

image-20210507223147155