BACKGROUND: Tumor spread through air spaces (STAS) has three morphologic subtypes: single cells, micropapillary clusters, and solid nests. However, whether their respective clinical significance is similar remains unclear. METHODS: We retrospectively reviewed 803 patients with resected non-small cell lung cancer (NSCLC) from January to December 2009. Recurrence-free survival (RFS) and overall survival (OS) were compared among patients stratified by STAS subtypes. We also performed a prospective study of NSCLC resection specimens to evaluate the influence of a prosecting knife on the presence of STAS subtypes during specimen handling (83 cases). RESULTS: STAS was found in 370 NSCLCs (46%), including 47 single cell STAS (13%), 187 micropapillary cluster STAS (50%), and 136 solid nest STAS (37%). STAS-negative patients had significantly better survival than patients with micropapillary cluster STAS (RFS: P < 0.001; OS: P < 0.001) and solid nest STAS (RFS: P < 0.001; OS: P < 0.001), but similar survival compared with those with single cell STAS (RFS: P = 0.995; OS: P = 0.71). Multivariate analysis revealed micropapillary cluster (RFS: P < 0.001; OS: P < 0.001) and solid nest STAS (RFS: P = 0.001; OS: P = 0.003) to be an independent prognostic indicator, but not for single cell STAS (RFS: P = 0.989; OS: P = 0.68). Similar results were obtained in subgroup analysis of patients with adenocarcinoma. The prospective study of NSCLC specimens suggested that 18 cases were considered as STAS false-positive, and most were singe cell pattern (13/18, 72%). CONCLUSIONS: Single cell STAS was the common morphologic type of artifacts produced by a prosecting knife. A precise protocol of surgical specimen handling is required to minimize artifacts as much as possible.
BACKGROUND: Tumor spread through air spaces (STAS) has three morphologic subtypes: single cells, micropapillary clusters, and solid nests. However, whether their respective clinical significance is similar remains unclear. METHODS: We retrospectively reviewed 803 patients with resected non-small cell lung cancer (NSCLC) from January to December 2009. Recurrence-free survival (RFS) and overall survival (OS) were compared among patients stratified by STAS subtypes. We also performed a prospective study of NSCLC resection specimens to evaluate the influence of a prosecting knife on the presence of STAS subtypes during specimen handling (83 cases). RESULTS: STAS was found in 370 NSCLCs (46%), including 47 single cell STAS (13%), 187 micropapillary cluster STAS (50%), and 136 solid nest STAS (37%). STAS-negative patients had significantly better survival than patients with micropapillary cluster STAS (RFS: P < 0.001; OS: P < 0.001) and solid nest STAS (RFS: P < 0.001; OS: P < 0.001), but similar survival compared with those with single cell STAS (RFS: P = 0.995; OS: P = 0.71). Multivariate analysis revealed micropapillary cluster (RFS: P < 0.001; OS: P < 0.001) and solid nest STAS (RFS: P = 0.001; OS: P = 0.003) to be an independent prognostic indicator, but not for single cell STAS (RFS: P = 0.989; OS: P = 0.68). Similar results were obtained in subgroup analysis of patients with adenocarcinoma. The prospective study of NSCLC specimens suggested that 18 cases were considered as STAS false-positive, and most were singe cell pattern (13/18, 72%). CONCLUSIONS: Single cell STAS was the common morphologic type of artifacts produced by a prosecting knife. A precise protocol of surgical specimen handling is required to minimize artifacts as much as possible.
Authors: Erik Thunnissen; Hans J L G Blaauwgeers; Erienne M V de Cuba; Ching Yong Yick; Douglas B Flieder Journal: Arch Pathol Lab Med Date: 2016-03 Impact factor: 5.534
Authors: Hans Blaauwgeers; Douglas Flieder; Arne Warth; Alexander Harms; Kim Monkhorst; Birgit Witte; Erik Thunnissen Journal: Am J Surg Pathol Date: 2017-09 Impact factor: 6.394
Authors: Maristela L Onozato; Alexandra E Kovach; Beow Y Yeap; Vicente Morales-Oyarvide; Veronica E Klepeis; Swathi Tammireddy; Rebecca S Heist; Eugene J Mark; Dora Dias-Santagata; A John Iafrate; Yukako Yagi; Mari Mino-Kenudson Journal: Am J Surg Pathol Date: 2013-02 Impact factor: 6.394
Authors: Takashi Eguchi; Koji Kameda; Shaohua Lu; Matthew J Bott; Kay See Tan; Joseph Montecalvo; Jason C Chang; Natasha Rekhtman; David R Jones; William D Travis; Prasad S Adusumilli Journal: J Thorac Oncol Date: 2018-09-19 Impact factor: 15.609