The Annals of thoracic surgery
May 12, 2026 · via Europe PMC
Diagnosis of the Novel IASLC Grading System Using Intraoperative Frozen Section (ECTOP-1014): A Prospective, Multicenter Clinical Trial.
Fu F, Jin Y, Deng C, +18 more, Li Y.
AI summary — for doctors, generated from the abstract only
Intraoperative frozen section correctly identified the IASLC grade of early-stage lung adenocarcinoma in about 80% of cases, with lepidic and micropapillary patterns most often misdiagnosed.
What was studied
Prospective multicentre clinical trial (ECTOP-1014, NCT05794698; 2022-2023) comparing frozen section with final pathology for IASLC grading.
Key findings
- Overall concordance 79.9%; weighted kappa 0.627
- Lepidic and micropapillary predominant patterns independently associated with misdiagnosis (specific statistic not fully captured in the abstract)
Clinical relevance
This suggests frozen section could inform intraoperative decisions such as extent of resection, but its impact on outcomes is unproven and certain patterns warrant caution.
Who should care
Limitations
Sample size not stated in the abstract; outcome impact of frozen-section-guided decisions not evaluated.
Frozen section gets the lung adenocarcinoma grade right about four times out of five.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
The International Association for the Study of Lung Cancer (IASLC) proposed a novel grading system for invasive nonmucinous adenocarcinoma. This study aimed to evaluate the accuracy of intraoperative frozen section in diagnosing IASLC grades in early-stage lung adenocarcinoma and to identify factors associated with potential misdiagnosis.
Methods
This was a prospective, multicenter clinical trial from Eastern Cooperative Thoracic Oncology Projects (ECTOP-1014, NCT05794698), conducted from July 2022 to August 2023. Frozen section results were compared with final pathology to assess diagnostic concordance. Logistic regression was used to identify predictors of frozen section misdiagnosis.
Results
The overall concordance rate between frozen section and final pathology in diagnosing IASLC grades was 79.9%, with a weighted κ of 0.627, indicating good agreement. Lepidic and micropapillary predominant patterns were independently associated with high misdiagnosis rates (P < .001). Interobserver agreement between pathologists was very good (κ = 0.821). With incorporation of frozen section into the model identifying grade 3 tumors, the area under the curve reached 0.907.
Conclusions
Frozen section demonstrated favorable precision in diagnosing IASLC grades and could provide supplemental information that may aid in surgical decision-making. However, certain histologic patterns, such as lepidic and micropapillary, may lead to higher rates of misdiagnosis. Further studies are required to validate these findings and to explore the impact of frozen section-guided decisions on patient outcomes.
DOI
10.1016/j.athoracsur.2026.04.050
PMID
42119754
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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