, Lung fact sheets. The Global Cancer Observatory, 2018.

, International association for the lung cancer study, IASLC 2015 Statement on Tobacco Control and Smoking Cessation, 2015.

, What is non small cell lung cancer?, 2016.

M. Zheng, Classification and Pathology of Lung Cancer, Surg Oncol Clin N Am, vol.25, issue.3, pp.447-68, 2016.

W. D. Travis, E. Brambilla, A. G. Nicholson, Y. Yatabe, J. Austin et al., The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. sept, vol.10, issue.9, pp.1243-60, 2015.

J. D. Brierley, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of MALIGNANT TUMOURS. Eighth Edition

K. Kadota, J. Nitadori, C. S. Sima, H. Ujiie, N. P. Rizk et al., 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, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. mai, vol.10, issue.5, pp.806-820, 2015.

A. Warth, T. Muley, C. A. Kossakowski, B. Goeppert, P. Schirmacher et al., Prognostic Impact of Intra-alveolar Tumor Spread in Pulmonary Adenocarcinoma, Am J Surg Pathol. juin, vol.39, issue.6, pp.793-801, 2015.

Y. Ren, H. Xie, C. Dai, Y. She, H. Su et al., Prognostic Impact of Tumor Spread Through Air Spaces in Sublobar Resection for 1A Lung Adenocarcinoma Patients, Ann Surg Oncol. juin, vol.26, issue.6, pp.1901-1909, 2019.

H. Uruga, T. Fujii, S. Fujimori, T. Kohno, and K. Kishi, Semiquantitative Assessment of Tumor Spread through Air Spaces (STAS) in Early-Stage Lung Adenocarcinomas, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer, vol.12, issue.7, pp.1046-51, 2017.

G. Toyokawa, Y. Yamada, T. Tagawa, F. Kinoshita, Y. Kozuma et al., Significance of Spread Through Air Spaces in Resected Lung Adenocarcinomas With Lymph Node Metastasis, Clin Lung Cancer, vol.19, issue.5, pp.395-400, 2018.

G. Toyokawa, Y. Yamada, T. Tagawa, Y. Kozuma, T. Matsubara et al., Significance of Spread Through Air Spaces in Resected Pathological Stage I Lung Adenocarcinoma, Ann Thorac Surg, vol.105, issue.6, pp.1655-63, 2018.

S. Shiono and N. Yanagawa, Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma, Interact Cardiovasc Thorac Surg, vol.23, issue.4, pp.567-72, 2016.

L. Yang, Y. Yang, P. Ma, B. Zheng, W. Liu et al., Spread through air spaces predicts a worse survival in patients with stage I adenocarcinomas >2 cm after radical lobectomy, J Thorac Dis, vol.10, issue.9, pp.5308-5325, 2018.

C. Dai, H. Xie, H. Su, Y. She, E. Zhu et al., Tumor Spread through Air Spaces Affects the Recurrence and Overall Survival in Patients with Lung Adenocarcinoma >2 to 3 cm, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer, vol.12, issue.7, pp.1052-60, 2017.

K. Kadota, Y. Kushida, N. Katsuki, R. Ishikawa, E. Ibuki et al., Tumor Spread Through Air Spaces Is an Independent Predictor of Recurrence-free Survival in Patients With Resected Lung Squamous Cell Carcinoma, Am J Surg Pathol. août, vol.41, issue.8, pp.1077-86, 2017.

S. Lu, K. S. Tan, K. Kadota, T. Eguchi, S. Bains et al., Spread through Air Spaces (STAS) Is an Independent Predictor of Recurrence and Lung Cancer-Specific Death in Squamous Cell Carcinoma, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer, vol.12, issue.2, pp.223-257, 2017.

N. Yanagawa, S. Shiono, M. Endo, and S. Ogata, Tumor spread through air spaces is a useful predictor of recurrence and prognosis in stage I lung squamous cell carcinoma, but not in stage II and III, Lung Cancer Amst Neth, vol.120, pp.14-21, 2018.

S. Yokoyama, T. Murakami, H. Tao, H. Onoda, A. Hara et al., Tumor Spread Through Air Spaces Identifies a Distinct Subgroup With Poor Prognosis in Surgically Resected Lung Pleomorphic Carcinoma, Chest. oct, vol.154, issue.4, pp.838-885, 2018.

M. L. Onozato, A. E. Kovach, B. Y. Yeap, V. Morales-oyarvide, V. E. Klepeis et al., Tumor islands in resected early-stage lung adenocarcinomas are associated with unique clinicopathologic and molecular characteristics and worse prognosis, Am J Surg Pathol. févr, vol.37, issue.2, pp.287-94, 2013.

J. Morimoto, T. Nakajima, H. Suzuki, K. Nagato, T. Iwata et al., Impact of free tumor clusters on prognosis after resection of pulmonary adenocarcinoma, J Thorac Cardiovasc Surg. juill, vol.152, issue.1, pp.64-72, 2016.

T. V. Colby, M. N. Koss, and E. D. Travis, Tumors of the Lower Respiratory Tract, 1995.

R. J. Ginsberg and L. V. Rubinstein, Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group, Ann Thorac Surg. sept, vol.60, issue.3, pp.622-623, 1995.

M. Kates, S. Swanson, and J. P. Wisnivesky, Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer<=1 cm in size: a review of SEER data, Chest. mars, vol.139, issue.3, pp.491-497, 2011.

J. P. Wisnivesky, C. I. Henschke, S. Swanson, D. F. Yankelevitz, J. Zulueta et al., Limited resection for the treatment of patients with stage IA lung cancer, Ann Surg. mars, vol.251, issue.3, pp.550-554, 2010.

T. Koike, Y. Yamato, K. Yoshiya, T. Shimoyama, and R. Suzuki, Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer, J Thorac Cardiovasc Surg. avr, vol.125, issue.4, pp.924-932, 2003.

J. Nitadori, A. J. Bograd, K. Kadota, C. S. Sima, N. P. Rizk et al., Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2cm or smaller, J Natl Cancer Inst. 21 août, vol.105, issue.16, pp.1212-1232, 2013.

T. Eguchi, K. Kameda, S. Lu, M. J. Bott, K. S. Tan et al., Lobectomy Is Associated with Better Outcomes than Sublobar Resection in Spread through Air Spaces (STAS)-Positive T1 Lung Adenocarcinoma: A Propensity Score-Matched Analysis, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. janv, vol.14, issue.1, pp.87-98, 2019.

K. Kadota, Y. Kushida, S. Kagawa, R. Ishikawa, E. Ibuki et al., Limited Resection is Associated With a Higher Risk of Locoregional Recurrence than Lobectomy in Stage I Lung Adenocarcinoma With Tumor Spread Through Air Spaces, Am J Surg Pathol. 17 mai, 2019.

A. E. Walts and A. M. Marchevsky, Current Evidence Does Not Warrant Frozen Section Evaluation for the Presence of Tumor Spread Through Alveolar Spaces, Arch Pathol Lab Med. janv, vol.142, issue.1, pp.59-63, 2018.

Y. Yeh, J. Nitadori, K. Kadota, A. Yoshizawa, N. Rekhtman et al., Using frozen section to identify histological patterns in stage I lung adenocarcinoma of ?3 cm: accuracy and interobserver agreement, Histopathology. juin, vol.66, issue.7, pp.922-960, 2015.

E. Thunnissen, H. Blaauwgeers, E. De-cuba, C. Y. Yick, and D. B. Flieder, Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung, Arch Pathol Lab Med. mars, vol.140, issue.3, pp.212-232, 2016.

H. Blaauwgeers, D. Flieder, A. Warth, A. Harms, K. Monkhorst et al., A Prospective Study of Loose Tissue Fragments in Non-Small Cell Lung Cancer Resection Specimens: An Alternative View to « Spread Through Air Spaces », Am J Surg Pathol. sept, vol.41, issue.9, pp.1226-1256, 2017.

M. L. Onozato, V. E. Klepeis, Y. Yagi, and M. Mino-kenudson, A role of three-dimensional (3D)-reconstruction in the classification of lung adenocarcinoma, Anal Cell Pathol Amst, vol.35, issue.2, pp.79-84, 2012.

H. Blaauwgeers, P. A. Russell, K. D. Jones, T. Radonic, and E. Thunnissen, Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): Invasive pattern or artifact? A critical review, Lung Cancer Amst Neth, vol.123, pp.107-118, 2018.

K. Kadota, J. Nitadori, C. S. Sima, H. Ujiie, N. P. Rizk et al., 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, J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. mai, vol.10, issue.5, pp.806-820, 2015.

, STAS) est décrite comme un nouveau processus d'invasion tumorale par l'Organisation Mondiale de la Santé et est définie comme la présence d'amas tumoraux micropapillaires ou solides ou de cellules tumorales isolées au sein des alvéoles du parenchyme pulmonaire environnant une tumeur. L'objectif de ce travail était d'évaluer l'impact pronostique des STAS sur la récidive et la survie de patients atteints, RESUME Introduction : La dissémination tumorale du cancer broncho-pulmonaire par voie endo-alvéolaire

, Matériel et Méthodes : 123 patients porteurs d'un adénocarcinome ou d'un carcinome épidermoïde non métastatique et traités chirurgicalement à la Clinique de l'Europe entre 2008 et 2016 ont été inclus

, En analyse multivariée, les patients STAS+ avaient un risque significativement plus élevé de récidive, vol.95, pp.12-16

, 84 -2 ,23) ; p=0,2). Les STAS étaient significativement associés aux adénocarcinomes micropapillaire (OR 13, p=0,02) que les patients STAS-, mais pas de récidive couplée au décès, vol.37, pp.72-113

, 014) et solide (OR 2,45, vol.95, pp.5-5

, Conclusion : Les STAS sont un facteur de risque de récidive chez les patients traités pour un carcinome non à petites cellules. Ils sont également associés aux contingents d'adénocarcinome micropapillaire et solide