基于术中快速冰冻切片指导外周型直径≤2 cm肺结节手术决策的胸外科专家共识

Expert consensus of thoracic surgeons on guiding surgical decision-making based on intraoperative frozen sections for peripheral pulmonary nodules with diameter≤2 cm

手术切除是治疗早期非小细胞肺癌的唯一根治性方法,术中冰冻切片(frozen section,FS)诊断肺结节性质具有准确性高、适用性广、并发症少和实时诊断等优势,已成为指导肺结节手术策略的主要手段之一。为此,我们检索了PubMed、Web of Science以及中国知网、万方等数据库近30年的相关文献和研究资料,召开了3次会议,采用德尔菲法制定了本专家共识,共达成6条共识内容:(1)术中快速FS诊断良恶性疾病;(2)肺癌类型的诊断:腺癌、鳞癌、其它等;(3)肺腺癌浸润程度诊断;(4)浸润性腺癌的组织学亚型诊断;(5)术中FS和术后石蜡诊断肺腺癌浸润程度不一致的处理策略;(6)术中FS诊断肿瘤沿气腔播散、脏层胸膜侵犯和淋巴管浸润。最终,提出11条推荐意见,以期为术中FS诊断肺结节指导外周型非小细胞肺癌手术决策提供参考,进一步提高早期肺癌个体化精准诊疗水平。

Surgical resection is the only radical method for the treatment of early-stage non-small cell lung cancer.Intraoperative frozen section(FS)has the advantages of high accuracy,wide applicability,few complications and real-time diagnosis of pulmonary nodules.It is one of the main means to guide surgical strategies for pulmonary nodules.Therefore,we searched PubMed,Web of Science,CNKI,Wanfang and other databases for nearly 30 years of relevant literature and research data,held 3 conferences,and formulated this consensus by using the Delphi method.A total of 6 consensus contents were proposed:(1)Rapid intraoperative FS diagnosis of benign and malignant diseases;(2)Diagnosis of lung cancer types including adenocarcinoma,squamous cell carcinoma,others,etc;(3)Diagnosis of lung adenocarcinoma infiltration degree;(4)Histological subtype diagnosis of invasive adenocarcinoma;(5)The treatment strategy of lung adenocarcinoma with inconsistent diagnosis on degree of invasion between intraoperative FS and postoperative paraffin diagnosis;(6)Intraoperative FS diagnosis of tumor spread through air space,visceral pleural invasion and lymphovascular invasion.Finally,we gave 11 recommendations in the above 6 consensus contents to provide a reference for diagnosis of pulmonary nodules and guiding surgical decision-making for peripheral non-small cell lung cancer using FS,and to further improve the level of individualized and precise diagnosis and treatment of early-stage lung cancer.