Tumor Spread through Air Spaces is an Important Pattern of Invasion and Impacts the Frequency and Location of Recurrences after Limited Resection for Small Stage I Lung Adenocarcinomas

The authors reviewed patients with small resected stage I lung adenocarcinoma to determine the frequency of tumor cells spreading through airway spaces (STAS) and their relationship to recurrent cancer. Nearly 40% of patients had tumor cells in the airways beyond the edge of the main tumor.  In patients undergoing parenchymal-sparing operations, the recurrence rate was much higher in patients with tumor STAS (43% vs 11%).  This relationship was not identified in patients undergoing lobectomy.  Tumor STAS should be recognized as a pattern of invasive spread among patients with lung adenocarcinoma.