Analysis of Factors Affecting the Diagnostic Efficacy of Frozen Sections for Tumor Spread Through Air Spaces in Lung Adenocarcinoma

<b>Objectives</b>: This study aimed to determine the factors affecting the diagnostic efficacy of frozen sections for assessing tumor spread through air spaces (STAS) and to provide suggestions for the sampling of these frozen sections. <b>Methods</b>: Cases of invasive adenocarcinoma with a pathological diagnosis of stage IA-IIIB were screened, and frozen and paraffin sections were reviewed. Using paraffin sections as the gold standard, the consistency of frozen pathological diagnosis of STAS was calculated. Factors that may affect STAS diagnosis in frozen sections were screened, and a nomogram was drawn. <b>Results</b>: The sensitivity of frozen sections in STAS diagnosis was 55.4% (108/195), the specificity was 74.5% (254/321), and the kappa value was 0.35. In the subsequent logistic regression, the ratio of the tissue diameters of the frozen and paraffin sections, number of frozen section sheets, clarity of the tumor boundary, and number of alveoli from the peritumoral area to tissue edge were all statistically significantly significant (<i>p</i> < 0.05) factors affecting the frozen STAS diagnostic efficacy. <b>Conclusions</b>: The diagnostic efficacy of frozen sections for STAS is poor. In our study, the tissue diameter ratio of the frozen to paraffin sections, the number of frozen sections, the clarity of the tumor boundary, and the number of alveoli from the peritumoral tissue to the tissue edge were considered independent factors affecting diagnostic consistency. The accuracy of the frozen section analysis in STAS diagnosis can be improved by our reasonable suggestions on frozen sampling, making it a reliable indicator of the surgical method.