Clinical Significance of Dual-Block Elastic Stain Evaluating Visceral Pleural Invasion in Peripheral Non-Small Cell Lung Cancer.

Abstract

Visceral pleural invasion (VPI) is a critical component in the staging of peripheral non-small cell lung carcinoma (NSCLC). We aim to investigate whether dual-block elastic stain increases visceral pleural invasion positivity compared with single-block elastic stain. We further analyze the potential predictors of visceral pleural invasion. 8419 peripheral NSCLC patients (including 6008 patients with tumor size≤3 cm in stage I) were divided into a cohort using one paraffin block (single-block group, n = 5184) and a cohort using dual paraffin blocks (dual-block group, n = 3235) for elastic stain. The VPI-positive rate demonstrated by the dual-block elastic stains group was significantly higher than that of the single-block elastic stain group (17.7% (573/3235) versus 9.1% (474/5184), respectively, P < .001). The presence of visceral pleural invasion in T1 (≤3 cm) patients detected by single- and dual-block elastic stain was 6.3% (235/3730) and 12.0% (273/2278), respectively (P < .001). 5.7% of T1 patients (stage IA) were additionally upstaged to T2a (stage IB) by dual-block elastic stain. However, the incidence of visceral pleural invasion in pT2a patients showed no significant difference between the single-block group and the dual-block group (16.8% vs. 17.1%, P = .916). Lymphovascular invasion, lymph node metastasis, dedifferentiated carcinomas, the presence of spread through airspaces (STAS) and a poorly differentiated adenocarcinomatous growth pattern could be significant predictors of visceral pleural invasion (P < .001). Our results indicate that using dual-block elastic stain identifies more visceral pleural invasion positive T1 NSCLC patients who are upstaged to T2a, and who could benefit from optimal management post-operatively. The application of dual-block elastic stain is an efficient and practical method to detect visceral pleural invasion status.

• Authors: Shaoling Li, Yan Huang, Lingping Zhang, Zhengwei Dong, Wei Wu, Wei Zhang, Chunyan Wu, Likun Hou
• Journal: International journal of surgical pathology (Int J Surg Pathol) Vol. 31 Issue 2 Pg. 175-183 (Apr 2023) ISSN: 1940-2465 [Electronic] United States
• PMID: 35758404 (Publication Type: Journal Article)

Chemical References

• Coloring Agents
• Paraffin

Topics

• Humans
• Carcinoma, Non-Small-Cell Lung (diagnosis, pathology)
• Lung Neoplasms (pathology)
• Coloring Agents
• Clinical Relevance
• Paraffin
• Neoplasm Staging
• Neoplasm Invasiveness (pathology)
• Retrospective Studies
• Prognosis