Diagnosis of the Novel IASLC Grading System Using Intraoperative Frozen Section (ECTOP-1014): A Prospective, Multicenter Clinical Trial.
Ann Thorac SurgMay 12, 2026 (epub)
Fangqiu Fu, Yan Jin, Chaoqiang Deng et al.
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In 30 seconds
This prospective, multicenter clinical trial evaluated the accuracy of intraoperative frozen section in diagnosing IASLC grades in early-stage lung adenocarcinoma. The study found an overall concordance rate of 79.9% between frozen section and final pathology, indicating good agreement. Factors such as lepidic and micropapillary patterns were associated with higher misdiagnosis rates.
Key findings
- The concordance rate between frozen section and final pathology for IASLC grades was 79.9%.
- Lepidic and micropapillary predominant patterns were linked to high misdiagnosis rates (P < .001).
- Interobserver agreement among pathologists was very good, with a κ of 0.821.
- Incorporating frozen section into the model for grade 3 tumors achieved an area under the curve of 0.907.
Why it matters
Accurate grading of lung adenocarcinoma is crucial for treatment planning and prognostication. This study highlights the potential of frozen section analysis to assist in real-time surgical decision-making, although certain histologic patterns may complicate diagnosis.