Abstract

BackgroundTissue harvesting for patients with a lung nodule is sometimes unsuitable due to the size and location of the nodule. In such cases, it is unclear whether it is acceptable to proceed to definitive lobectomy without intraoperative frozen section analysis.MethodsWe retrospectively reviewed patients who underwent definitive lobectomy or wedge resection for frozen section analysis at our institution between 2014 and 2018. The sensitivity, specificity, and accuracies of the clinical and frozen section diagnoses were evaluated against the final pathological diagnosis.ResultsThere were 141 patients in the definitive lobectomy group and 58 patients in the frozen section analysis group, with the latter having smaller and less deep nodules and a lower rate of malignancy on clinical and final pathological diagnoses. The sensitivity, specificity, and accuracy of the clinical diagnosis were 100%, 82%, and 95%, respectively, in the frozen section analysis group and 99%, 67%, and 97%, respectively, in the definitive lobectomy group; values of frozen section diagnosis were 98%, 82%, and 93%, respectively. On subgroup analysis, all ground‐glass nodules clinically diagnosed as malignant had a final pathological diagnosis of malignancy.ConclusionsThe accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis. These data suggest that definitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground‐glass nodules clinically diagnosed as malignant. To avoid unnecessary lobectomy, frozen section diagnosis should be considered for nodules likely to be benign.Key pointsSignificant findings of the studyThe accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis.What this study addsDefinitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground‐glass nodules with a clinical diagnosis of malignancy.

Highlights

  • Lobectomy without frozen section discordant or the probability of malignancy is low to moderate, a non-surgical biopsy such as a transbronchial biopsy or a transthoracic needle biopsy is considered to proceed to definitive management.[4–7]

  • For patients with a lung nodule without a preoperative tissue diagnosis, radical surgery, generally lobectomy, is often performed after a diagnosis of malignancy from intraoperative frozen section analysis (FSA), with the tissue specimen obtained by wedge resection or needle biopsy.[8, 9]

  • They were subsequently assigned to the group of candidates either for definitive lobectomy (DL) or for wedge resection for FSA according to our surgical treatment algorithm for lung nodules without preoperative tissue diagnosis (Fig 1)

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Summary

Introduction

A few studies have reported initial definitive radical surgery in the absence of tissue diagnosis as an option for selected patients, reducing cost and shortening operative time and length of hospital stay.[13–15] It remains unclear whether it is acceptable to proceed to definitive lobectomy (DL) without intraoperative FSA. Tissue harvesting for patients with a lung nodule is sometimes unsuitable due to the size and location of the nodule In such cases, it is unclear whether it is acceptable to proceed to definitive lobectomy without intraoperative frozen section analysis. Conclusions: The accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis These data suggest that definitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground-glass nodules clinically diagnosed as malignant. Frozen section diagnosis should be considered for nodules likely to be benign

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