| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1755-1759
© 2004 The Society of Thoracic Surgeons
a Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
b Department of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
Accepted for publication May 3, 2004.
* Address reprint requests to Dr Marchevsky, Department of Pathology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
marchevsky{at}cshs.org
BACKGROUND: Pulmonary nodules are frequently first diagnosed by frozen section, immediately followed by lobectomy or other procedures. The frozen section diagnosis of pulmonary nodules can be difficult, as inflammatory and fibrotic lesions can be confused for malignancy, creating intraoperative dilemmas for pathologists and thoracic surgeons.
METHODS: We reviewed our experience at Cedars-Sinai Medical Center with the frozen section diagnoses of 183 consecutive pulmonary nodules smaller than 1.5 cm in diameter and calculated the sensitivity, specificity, and predictive values of this diagnostic procedure.
RESULTS: One hundred and seventy four nodules were correctly classified by frozen section as neoplastic or nonneoplastic, six lesions were diagnosed equivocally, and two neoplasms were missed owing to sampling errors. The equivocal frozen section diagnoses included two bronchioloalveolar carcinomas (BAC) interpreted as "atypical hyperplasia, favor BAC," two BAC diagnosed as "alveolar hyperplasia," and two carcinoid tumors labeled as "atypical carcinoma" and "spindle cell lesion, carcinoid versus sclerosing hemangioma," respectively. The sensitivities for a diagnosis of neoplasia were 86.9% and 94.1% for nodules smaller than 1.1 cm in diameter and measuring 1.1 to 1.5 cm, respectively. The diagnostic accuracy of frozen sections was significantly better in nodules larger than 1.0 cm in diameter (p = 0.05). There were no false-positive diagnoses of malignancy, resulting in 100% specificity.
CONCLUSIONS: Intraoperative consultation with frozen section is a sensitive and specific procedure for the diagnosis of malignancy from small pulmonary nodules. The distinction between BAC and atypical adenomatous hyperplasia, and of small peripheral carcinoid tumors from other lesions, can be difficult by frozen section. Thoracic surgeons need to become aware of these problems and develop appropriate therapeutic strategies.
This article has been cited by other articles:
|
|
 |
|
  R. Rami-Porta and M. Tsuboi Sublobar resection for lung cancer Eur. Respir. J., February 1, 2009; 33(2): 426 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Schwartz and D. E. Henson Diagnostic Surgical Pathology in Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 78S - 93S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Gould, J. Fletcher, M. D. Iannettoni, W. R. Lynch, D. E. Midthun, D. P. Naidich, and D. E. Ost Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 108S - 130S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Sakurai, Y. Dobashi, and M. Matsumoto Reply Ann. Thorac. Surg., November 1, 2005; 80(5): 1979 - 1979. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
