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
好久沒水過來水一水防泵，玩玩新圖床

Introduction

這兒就是比較老生常談的內(nèi)容就沒寫啥

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.

主要是要有術(shù)中快速病理翩概，然后要有對應(yīng)的術(shù)后病理（個人覺得只要有FSP大概率就會有NFP吧）算色；另一方面嗽测，片子上要有足夠多的邊界用于評估。

Reference Diagnoses

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

這篇文章STAS的標(biāo)注是，先讓三個高年資病理科醫(yī)生進(jìn)行讀片，然后基于一個標(biāo)準(zhǔn)來診斷STAS

• STAS:（這兒STAS用的經(jīng)典定義楼入，微乳頭簇哥捕，實性巢和單個腫瘤細(xì)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:（這兒定義了一下人工偽影，我覺得有一定的意義嘉熊，但是后面結(jié)果太爛了遥赚，就沒細(xì)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

這兒找了五個人來看，看兩輪阐肤，中間間隔一個半月凫佛，然后有三種，分別是“有STAS”孕惜、“沒有STAS”以及“模棱兩可的”

下面是一個我自己畫的圖圖

閱片流程

image

• A中間的STAS在B中被確定為微乳頭灶
• C中間不規(guī)則的腫瘤簇愧薛，在D圖中被確認(rèn)為偽影

image

• E圖坐車右邊看上去像微乳頭或者實性巢，左側(cè)的有很多鋸齒狀衫画，看上去像偽影毫炉，這種就是模糊的。F圖證明這個是STAS削罩，但同時也揭示這種模棱兩個的STAS可能是STAS和偽影的混合

• G圖的偽影在H圖上證明是STAS

Results

STAS Diagnosis

就是看看陽性陰性之間的區(qū)別吧

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.

大概意思就是在診斷STAS的過程中瞄勾，病理醫(yī)生個體間差異極大，并且經(jīng)過溝通之后鲸郊，不確定性增加了丰榴？

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

下面有點寫不下去了货邓，回頭來補充一下解讀吧

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