A Prospective Study of Loose Tissue Fragments in Non-Small Cell Lung Cancer Resection Specimens: An Alternative View to "Spread Through Air Spaces"

Hans Blaauwgeers, Douglas Flieder, Arne Warth, Alexander Harms, Kim Monkhorst, Birgit Witte, Erik Thunnissen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The World Health Organization Classification of Lung Tumors considers "Spread Through Air Spaces" a form of invasion in lung adenocarcinoma. The recently described spread of free-floating cell clusters during lung specimen sectioning, otherwise known as "Spread Through A Knife Surface," represents an ex vivo artifact. The purpose of this study was to prospectively investigate the presence and frequency of these free-floating tumor cell clusters in surgically resected lung cancer specimens and their possible relation to gross examination procedures. A prospective, multi-institutional study of non-small cell lung cancer resection specimen was undertaken. At prosection the first cut was made with a clean knife; the second cut was made in a parallel plane to the first. Four tissue blocks were taken from upper and lower parts of first and second cuts. Hematoxylin and eosin-stained slides were examined for displaced benign and/or malignant tissue fragments. Forty-four resection specimens were studied. The mean number of tumor clusters for blocks 1 to 4 was 0.36, 1.44, 1.86, and 1.95, respectively, and for benign fragments was 0.11, 0.11, 0.13, and 0.25, respectively. Almost all cell clusters were intra-alveolar. Comparison of tumor cell clusters in block 1 with blocks 2 to 4 was significant with P-values (Friedman test for repeated measures 0.03) 0.031, 0.02, and 0.05, respectively. Overall 93% of the loose tissue fragments could be explained by mechanical forces associated with tissue handling. While the 2015 World Health Organization Classification of Lung Tumors recognizes Spread Through Air Spaces as a form of lung cancer invasion, such is debatable and in many instances likely represents mechanical artifact, including dissemination along the prosecting knife blade.

Original languageEnglish
Pages (from-to)1226-1230
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume41
Issue number9
DOIs
Publication statusPublished - 2017

Cite this

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title = "A Prospective Study of Loose Tissue Fragments in Non-Small Cell Lung Cancer Resection Specimens: An Alternative View to {"}Spread Through Air Spaces{"}",
abstract = "The World Health Organization Classification of Lung Tumors considers {"}Spread Through Air Spaces{"} a form of invasion in lung adenocarcinoma. The recently described spread of free-floating cell clusters during lung specimen sectioning, otherwise known as {"}Spread Through A Knife Surface,{"} represents an ex vivo artifact. The purpose of this study was to prospectively investigate the presence and frequency of these free-floating tumor cell clusters in surgically resected lung cancer specimens and their possible relation to gross examination procedures. A prospective, multi-institutional study of non-small cell lung cancer resection specimen was undertaken. At prosection the first cut was made with a clean knife; the second cut was made in a parallel plane to the first. Four tissue blocks were taken from upper and lower parts of first and second cuts. Hematoxylin and eosin-stained slides were examined for displaced benign and/or malignant tissue fragments. Forty-four resection specimens were studied. The mean number of tumor clusters for blocks 1 to 4 was 0.36, 1.44, 1.86, and 1.95, respectively, and for benign fragments was 0.11, 0.11, 0.13, and 0.25, respectively. Almost all cell clusters were intra-alveolar. Comparison of tumor cell clusters in block 1 with blocks 2 to 4 was significant with P-values (Friedman test for repeated measures 0.03) 0.031, 0.02, and 0.05, respectively. Overall 93{\%} of the loose tissue fragments could be explained by mechanical forces associated with tissue handling. While the 2015 World Health Organization Classification of Lung Tumors recognizes Spread Through Air Spaces as a form of lung cancer invasion, such is debatable and in many instances likely represents mechanical artifact, including dissemination along the prosecting knife blade.",
keywords = "artifact, lung, NSCLC, pathology, STAKS, STAS",
author = "Hans Blaauwgeers and Douglas Flieder and Arne Warth and Alexander Harms and Kim Monkhorst and Birgit Witte and Erik Thunnissen",
year = "2017",
doi = "10.1097/PAS.0000000000000889",
language = "English",
volume = "41",
pages = "1226--1230",
journal = "American Journal of Surgical Pathology",
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}

A Prospective Study of Loose Tissue Fragments in Non-Small Cell Lung Cancer Resection Specimens : An Alternative View to "Spread Through Air Spaces". / Blaauwgeers, Hans; Flieder, Douglas; Warth, Arne; Harms, Alexander; Monkhorst, Kim; Witte, Birgit; Thunnissen, Erik.

In: American Journal of Surgical Pathology, Vol. 41, No. 9, 2017, p. 1226-1230.

Research output: Contribution to journalArticleAcademicpeer-review

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T2 - An Alternative View to "Spread Through Air Spaces"

AU - Blaauwgeers, Hans

AU - Flieder, Douglas

AU - Warth, Arne

AU - Harms, Alexander

AU - Monkhorst, Kim

AU - Witte, Birgit

AU - Thunnissen, Erik

PY - 2017

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