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

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。

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

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

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

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？

Overall, most FS slides would be correctly classified.

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