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Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective

Airspace invasion in lung cancer has been known over the last 30 years, but it was only recently that WHO 2015 formally recognized it as a mechanism of invasion with the terminology of tumor spread through air spaces (STAS). Multiple studies have shown the association of STAS with lower survival and...

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Autor principal: Mino-Kenudson, Mari
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354155/
https://www.ncbi.nlm.nih.gov/pubmed/32676351
http://dx.doi.org/10.21037/tlcr.2020.01.06
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author Mino-Kenudson, Mari
author_facet Mino-Kenudson, Mari
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description Airspace invasion in lung cancer has been known over the last 30 years, but it was only recently that WHO 2015 formally recognized it as a mechanism of invasion with the terminology of tumor spread through air spaces (STAS). Multiple studies have shown the association of STAS with lower survival and suggest that STAS is an independent prognostic factor across lung adenocarcinoma of all stages and in other histologic subtypes of lung cancer as well. Consequently, STAS is designated as an exclusion criterion of adenocarcinoma in situ and minimally invasive adenocarcinoma; thus, the presence of STAS impacts the diagnosis and staging of lung adenocarcinoma. Further, wedge resection and segmentectomy have been increasingly applied for small node negative tumors and the presence of STAS in those specimens may indicate the requirement of completion lobectomy. Given these significant clinical implications, we, pathologists, need to recognize and appropriately report STAS (possibly including at the time of intraoperative consultation). However, emerging data suggests that more work should be done to improve consensus and identification of STAS, including at frozen section. In this review, the evolution of our understanding of airspace invasion over the past decade, the clinical significance of STAS, and controversies and practical issues associated with the diagnosis of STAS are discussed.
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spelling pubmed-73541552020-07-15 Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective Mino-Kenudson, Mari Transl Lung Cancer Res Review Article on Selected Highlights of the 2019 Pulmonary Pathology Society Biennial Meeting Airspace invasion in lung cancer has been known over the last 30 years, but it was only recently that WHO 2015 formally recognized it as a mechanism of invasion with the terminology of tumor spread through air spaces (STAS). Multiple studies have shown the association of STAS with lower survival and suggest that STAS is an independent prognostic factor across lung adenocarcinoma of all stages and in other histologic subtypes of lung cancer as well. Consequently, STAS is designated as an exclusion criterion of adenocarcinoma in situ and minimally invasive adenocarcinoma; thus, the presence of STAS impacts the diagnosis and staging of lung adenocarcinoma. Further, wedge resection and segmentectomy have been increasingly applied for small node negative tumors and the presence of STAS in those specimens may indicate the requirement of completion lobectomy. Given these significant clinical implications, we, pathologists, need to recognize and appropriately report STAS (possibly including at the time of intraoperative consultation). However, emerging data suggests that more work should be done to improve consensus and identification of STAS, including at frozen section. In this review, the evolution of our understanding of airspace invasion over the past decade, the clinical significance of STAS, and controversies and practical issues associated with the diagnosis of STAS are discussed. AME Publishing Company 2020-06 /pmc/articles/PMC7354155/ /pubmed/32676351 http://dx.doi.org/10.21037/tlcr.2020.01.06 Text en 2020 Translational Lung Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Selected Highlights of the 2019 Pulmonary Pathology Society Biennial Meeting
Mino-Kenudson, Mari
Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title_full Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title_fullStr Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title_full_unstemmed Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title_short Significance of tumor spread through air spaces (STAS) in lung cancer from the pathologist perspective
title_sort significance of tumor spread through air spaces (stas) in lung cancer from the pathologist perspective
topic Review Article on Selected Highlights of the 2019 Pulmonary Pathology Society Biennial Meeting
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354155/
https://www.ncbi.nlm.nih.gov/pubmed/32676351
http://dx.doi.org/10.21037/tlcr.2020.01.06
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