Reporting of Incidental Thrombotic Arteriopathy in Lung Resection Specimens: Examination of Clinical Impact.

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-11-01 Epub Date: 2024-07-17 DOI:10.1097/PAS.0000000000002292
Andréanne Gagné, Robert F Padera, Rachel K Putman, Lynette M Sholl
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Abstract

Pulmonary thrombotic arteriopathy (PTA) can be an incidental finding in lung resections performed for various indications. Historic studies largely examined PTA in autopsies. Thus, the prevalence in surgical samples, particularly in the modern era of lung cancer screening, is poorly defined. Detection of PTA in surgical samples may provide an opportunity for therapeutic intervention, but the impact of this finding on clinical management is unknown. We retrospectively examined consecutive lung surgical resections containing a report of incidental PTA between 2019 and 2022 in our institution. A retrospective chart review was performed to determine the history of systemic thromboembolism and clinical and radiographic follow-up. All slides were reviewed to morphologically characterize the vascular changes. Among 2930 pulmonary resections, 66 (2.3%) reportedly contained PTA. Twenty-four (36.4%) patients had a clinically recognized thromboembolic event either before or after surgical resection. Patients with clinically recognized thromboembolic disease were significantly more likely to have both acute and organized thrombi affecting large arteries. The presence of infarct, chronic hypertensive vasculopathy, or number of vessels with thrombi were not significantly associated with a clinically detected event. Reporting of incidental PTA led to clinical intervention in six patients and confirmed systemic thromboembolic disease in 2. Moreover, 2 patients with no further workup based on the incidental pathology findings subsequently developed pulmonary embolism. PTA is incidentally detected in 2.3% of surgical lung resections, and in two-thirds of cases, there is no clinical suspicion of thromboembolic disease. Pathologic reporting of PTA rarely led to clinical intervention, suggesting a need for improved communication of incidental pathology findings.

报告肺切除标本中的意外血栓性动脉病变:临床影响研究。
肺血栓性动脉病变(PTA)可能是因各种原因进行肺切除术时偶然发现的。以往的研究主要是对尸检中的 PTA 进行研究。因此,手术样本中的发病率,尤其是在现代肺癌筛查时代的发病率尚不明确。在手术样本中发现 PTA 可为治疗干预提供机会,但这一发现对临床管理的影响尚不清楚。我们回顾性地检查了本院在 2019 年至 2022 年期间连续进行的肺部手术切除,其中包含一份附带 PTA 的报告。我们进行了回顾性病历审查,以确定全身血栓栓塞病史以及临床和影像学随访情况。对所有切片进行了复查,以确定血管病变的形态特征。在2930例肺部切除术中,有66例(2.3%)报告含有PTA。24例(36.4%)患者在手术切除之前或之后发生了临床公认的血栓栓塞事件。临床公认的血栓栓塞性疾病患者中,有急性和有组织血栓影响大动脉的几率明显更高。是否存在梗死、慢性高血压血管病变或有血栓的血管数量与临床发现的血栓事件无明显关联。6名患者因报告偶然的PTA而接受了临床干预,2名患者确诊为全身性血栓栓塞性疾病。此外,2名患者因偶然的病理发现而未接受进一步检查,随后发展为肺栓塞。2.3%的肺切除手术会偶然发现PTA,其中三分之二的病例临床上并未怀疑有血栓栓塞性疾病。PTA 的病理报告很少会导致临床干预,这表明需要改进偶然病理发现的交流。
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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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