Andréanne Gagné, MD PhD

Rank

Fellow

Department

Pathology

Thoracic Pathology

Authors

Andréanne Gagné*, Robert F. Padera, Rachel K. Putman, Lynette M. Sholl

Principal Investigator

Lynette M. Sholl

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Categories

Clinical impact of reporting incidental thrombotic arteriopathy in lung resection specimens

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Abstract

Pulmonary thrombotic arteriopathy (PTA) may be detected incidentally in lung resections. 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 provides an opportunity for diagnostic and therapeutic intervention, but the impact of this finding on clinical management is unknown.

We retrospectively examined consecutive patients with a lung surgical resection and an incidental finding of PTA between 2019-2022. Data collected included standard clinicopathological characteristics and history of systemic thromboembolism. Slides were reviewed to describe the thromboembolic disease. Impact of the pathology findings on post-surgical management was defined as the addition of imaging studies, other relevant tests, or anticoagulation therapy. The associations between clinicopathological characteristics and clinical manifestations of PTA were assessed by chi-square tests and ROC curves.

Among 2324 pulmonary resections, 68 (2.93%) contained PTA. Among samples with PTA, clinically-recognized thromboembolic disease was identified in 36.8% of patients; clinicopathologic features were similar between patients with and without clinically-recognized disease. Early organizing thrombi or thrombi of varied age (p=0.038) and affecting proximal arteries (p=0.009) are more likely to be associated with clinically-recognized disease, while the number of thrombus (area under the curve = 0.554), distance to tumor (p=0.907), presence of infarct (p=0.078), and concomitant pulmonary arterial hypertensive changes (p=0.751) were not. Reporting of incidental PTA led to clinical intervention in five patients (7.4%) and confirmed systemic thromboembolic disease in two. Moreover, two patients with PTA and without additional postoperative workup subsequently developed pulmonary embolism.

Pulmonary thrombotic arteriopathy is incidentally detected in <3% of surgical lung resections; in most cases, there is no antecedent clinical suspicion for thromboembolic disease. The pathologic findings only rarely led to a clinical intervention, suggesting a need for improved communication of incidental pathology findings.