Gross Specimen Handling Procedures Do Not Impact the Occurrence of Spread Through Air Spaces (STAS) in Lung Cancer.
Journal
The American journal of surgical pathology
ISSN: 1532-0979
Titre abrégé: Am J Surg Pathol
Pays: United States
ID NLM: 7707904
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
17
12
2020
medline:
23
2
2021
entrez:
16
12
2020
Statut:
ppublish
Résumé
Spread Through Air Spaces (STAS) is a form of invasion characterized by neoplastic cell dissemination in the lung parenchyma surrounding the outer edge of the tumor. Its possible artifactual origin is widely debated in the literature. The aim of this study is to investigate the potential impact of gross sampling procedures in causing STAS. A prospective series of 51 surgical lung specimens was collected (35 adenocarcinomas, 68.6%; 13 squamous cell carcinomas, 25.5%; 2 large-cell neuroendocrine carcinomas, 3.9%; 1 atypical carcinoid, 2%). The fresh tissue was sectioned with a new and clean blade for each cut, to obtain a tissue slice comprising the upper lung parenchyma, the tumor, and the lower parenchyma. This slice was cut in half and separately processed. The same procedure was repeated in the residual (specular) specimen after formalin fixation. STAS was identified in 33/51 (64.7%) cases, the predominant pattern being cluster formation (29 cases, 87.9%), the remaining 4 cases having single-cell invasion. Comparing STAS detection in upper and lower lung parenchyma areas (ie, before and after the blade crossed the tumor), no significant preferential STAS distribution was observed, indeed being almost overlapping (60.6% and 63.6% for fresh and 61.3% and 65.6% for fixed tissues, respectively). There was no difference between STAS occurrence in freshly cut and fixed corresponding samples. These findings indicate that STAS is not a pathologist-related artifactual event because of knife transportation of tumor cells during gross specimen handling and support the notion that it is a phenomenon preexisting to surgical tissue processing.
Identifiants
pubmed: 33323894
pii: 00000478-202102000-00009
doi: 10.1097/PAS.0000000000001642
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
215-222Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Références
Kadota K, Nitadori JI, Sima CS, et al. Tumor Spread Through Air Spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas. J Thorac Oncol. 2015;10:806–814.
Clayton F. Bronchioloalveolar carcinomas. Cell types, patterns of growth, and prognostic correlates. Cancer. 1986;57:1555–1564.
Onozato ML, Kovach AE, Yeap BY, et al. Tumor islands in resected early-stage lung adenocarcinomas are associated with unique clinicopathologic and molecular characteristics and worse prognosis. Am J Surg Pathol. 2013;37:287–294.
Travis WD, Brambilla E, Burke AP, et al. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart, 4th ed. Lyon, France: IARC; 2015:33.
Altinay S, Metovic J, Massa F, et al. Spread Through Air Spaces (STAS) is a predictor of poor outcome in atypical carcinoids of the lung. Virchows Arch. 2019;475:325–334.
Aly RG, Rekhtman N, Li X, et al. Spread Through Air Spaces (STAS) is prognostic in atypical carcinoid, large cell neuroendocrine carcinoma, and small cell carcinoma of the lung. J Thorac Oncol. 2019;14:1583–1593.
Ma K, Zhan C, Wang S, et al. Spread Through Air Spaces (STAS): a new pathologic morphology in lung cancer. Clin Lung Cancer. 2019;20:e158–e162.
Kadota K, Kushida Y, Katsuki N, et al. Tumor Spread Through Air Spaces is an independent predictor of recurrence-free survival in patients with resected lung squamous cell carcinoma. Am J Surg Pathol. 2017;41:1077–1086.
Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stage I lung adenocarcinoma with tumor Spread Through Air Spaces. Am J Surg Pathol. 2019;43:1033–1041.
Morimoto J, Nakajima T, Suzuki H, et al. Impact of free tumor clusters on prognosis after resection of pulmonary adenocarcinoma. J Thorac Cardiovasc Surg. 2016;152:64.e1–72.e1.
Warth A, Muley T, Kossakowski CA, et al. Prognostic impact of intra-alveolar tumor spread in pulmonary adenocarcinoma. Am J Surg Pathol. 2015;39:793–801.
Vaghjiani RG, Takahashi Y, Eguchi T, et al. Tumor Spread Through Air Spaces is a predictor of occult lymph node metastasis in clinical stage IA lung adenocarcinoma. J Thorac Oncol. 2020;15:792–802.
Blaauwgeers H, Flieder D, Warth A, et al. A prospective study of loose tissue fragments in non-small cell lung cancer resection specimens: an alternative view to “Spread Through Air Spaces. Am J Surg Pathol. 2017;41:1226–1230.
Pelosi G, Nesa F, Taietti D, et al. Spread of hyperplastic pulmonary neuroendocrine cells into air spaces (S.H.I.P.M.E.N.T.S): a proof for artifact. Lung Cancer. 2019;137:43–47.
Blaauwgeers H, Russell PA, Jones KD, et al. Pulmonary loose tumor tissue fragments and Spread Through Air Spaces (STAS): Invasive pattern or artifact? A critical review. Lung Cancer. 2018;123:107–111.
Warth A. Spread Through Air Spaces (STAS): a comprehensive update. Transl Lung Cancer Res. 2017;6:501–507.
Yagi Y, Aly RG, Tabata K, et al. Three-dimensional histologic, immunohistochemical, and multiplex immunofluorescence analyses of dynamic vessel co-option of Spread Through Air Spaces in lung adenocarcinoma. J Thorac Oncol. 2020;15:589–600.
Zhao C, Yang H, Shi H, et al. Distinct contributions of angiogenesis and vascular co-option during the initiation of primary microtumors and micrometastases. Carcinogenesis. 2011;32:1143–1150.
Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 Classification. J Thorac Oncol. 2015;10:1243–1260.
Thunnissen E, Blaauwgeers HJLG, De Cuba EMV, et al. Ex vivo artifacts and histopathologic pitfalls in the lung. Arch Pathol Lab Med. 2016;140:212–220.