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Hojat SA, Maheshwari BK, Ravish NA, Azabdaftari G, Yang Z. Utility of rapid
on‐site
evaluation in procurement of adrenal gland tissue biopsies. Diagn Cytopathol 2022; 50:557-564. [DOI: 10.1002/dc.25036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Seyed Amin Hojat
- Department of Pathology Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Bhunesh K. Maheshwari
- Department of Pathology Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Nakul A. Ravish
- Department of Pathology Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Gissou Azabdaftari
- Department of Pathology Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Zhongbo Yang
- Department of Pathology Roswell Park Comprehensive Cancer Center Buffalo New York USA
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Ahmed AA, Thomas AJ, Ganeshan DM, Blair KJ, Lall C, Lee JT, Morshid AI, Habra MA, Elsayes KM. Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management. Abdom Radiol (NY) 2020; 45:945-963. [PMID: 31894378 DOI: 10.1007/s00261-019-02371-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Most tumors are either metastatic or locally invasive at the time of diagnosis. Differentiation between ACC and other adrenal masses depends on clinical, biochemical, and imaging factors. This review will discuss the genetics, pathological, and imaging feature of ACC.
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Affiliation(s)
- Ayahallah A Ahmed
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Dhakshina Moorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Katherine J Blair
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James T Lee
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Ali I Morshid
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed A Habra
- Departments of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Simsek FS, Arslan M, Dag Y. An exceptional group of non-small cell lung cancer difficult to diagnose: Evaluation of lipid-poor adrenal lesions. Bosn J Basic Med Sci 2019; 19:195-200. [PMID: 30997878 DOI: 10.17305/bjbms.2019.3837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
In some non-small cell lung cancer (NSCLC) patients, lipid-poor adrenal adenomas cannot be adequately differentiated from metastases using imaging methods. Invasive diagnostic procedures also have a low negative predictive value (NPV) in such cases. The current study aims to establish a specific and clinically practical metabolic parameter for lipid-poor adrenal lesions (ALs) in NSCLC patients. This diagnostic approach may prevent unnecessary abdominal enhanced computed tomography (CT), magnetic resonance imaging, or invasive diagnostic procedures. Sixty-four NSCLC patients with 69 lipid-poor ALs and 28 control patients with 30 benign lipid-poor ALs, who underwent FDG-PET/CT, were retrospectively reviewed. Two morphological and four metabolic parameters were analyzed in FDG-PET/CT images of NSCLC and control patients. Baseline and post-chemotherapy images of 64 NSCLC patients were re-evaluated according to the PERCIST 1.0. In cases where ALs could not be differentiated, follow-up FDG-PET/CT images were re-examined. The receiver operating characteristic (ROC) curve method was used for the evaluation of diagnostic parameters. Out of 69 ALs, 39 were determined as metastatic lesions (adrenal metastasis), while 30 lesions were considered non-metastatic (adrenal adenomas). The mean attenuation value, SUVmax AL/SUVmax primary tumor, SUVmax, SUVmax AL/liver, and SUVmax AL/SUVmean liver were significantly different between metastatic and benign ALs from NSCLC patients. The SUVmax AL/SUVmean liver ≥1.81 had the best positive (PPV, 94.3%) and negative (NPV, 82.4%) predictive values, and the highest specificity (93.3%), sensitivity (84.6%) and accuracy (86.9%). Lipid-poor ALs with SUVmax AL/SUVmean liver ≥1.81 can be accepted as malignant in NSCLC. However, if SUVmax AL/SUVmean liver is <1.81, a pathologic examination is required. Utilizing this cut-off value to decide on adrenal core biopsy may prevent its unnecessary use. Moreover, this diagnostic approach can save time and reduce the healthcare costs.
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Affiliation(s)
- Fikri Selcuk Simsek
- Nuclear Medicine Department, Firat University Medical Faculty, Elazığ, Turkey.
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Chassagnon G, Bennani S, Freche G, Magdeleinat P, Mansuet-Lupo A, Revel MP. CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer. Br J Radiol 2018; 91:20180090. [PMID: 29906237 DOI: 10.1259/bjr.20180090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Increased fludeoxyglucose (FDG) uptake in morphologically normal adrenal glands on positron emission tomography-CT (PET-CT) is a diagnostic challenge with major implications on treatment. The purpose of this retrospective study was to report our experience of CT-guided percutaneous core biopsy of morphologically normal adrenal glands showing increased FDG uptake in a context of lung cancer. METHODS: Biopsies for non-enlarged adrenal glands showing increased FDG uptake in lung cancer patients performed at our institution from December 2014 to December 2016 were retrospectively analyzed. Six biopsies were performed in five patients during the study period. All procedures were performed with the patients in the prone position, using a posterior approach and coaxial 17-gauge needles with 18-gauge automated cutting needles. Patient characteristics, procedural details and final pathological diagnosis were analyzed, as well as the duration of hospitalization. RESULTS: Five of the six biopsies (83.3%) confirmed adrenal metastasis from the primary lung cancer. No complications were reported and the patients were discharged the day after the procedure. CONCLUSION: The high confirmation rate of metastasis and lack of complications support performing CT-guided percutaneous biopsy of non-enlarged adrenal glands showing increased FDG uptake, for optimal management in lung cancer patients. ADVANCES IN KNOWLEDGE: Morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer are metastasis. This manuscript shows that CT-guided percutaneous biopsy should be proposed. Increased FDG uptake in morphologically normal adrenal glands may indicate metastasis.
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Affiliation(s)
- Guillaume Chassagnon
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Souhail Bennani
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Gaël Freche
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Pierre Magdeleinat
- 2 Department of Thoracic Surgery, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Audrey Mansuet-Lupo
- 3 Department of Pathology, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Marie-Pierre Revel
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
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Perrino CM, Ho A, Dall CP, Zynger DL. Utility of GATA3 in the differential diagnosis of pheochromocytoma. Histopathology 2017; 71:475-479. [DOI: 10.1111/his.13229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Carmen M Perrino
- Department of Pathology; The Ohio State University Medical Center; Columbus OH USA
| | - Alex Ho
- Department of Pathology; The Ohio State University Medical Center; Columbus OH USA
| | - Christopher P Dall
- Department of Pathology; The Ohio State University Medical Center; Columbus OH USA
| | - Debra L Zynger
- Department of Pathology; The Ohio State University Medical Center; Columbus OH USA
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Delivanis DA, Erickson D, Atwell TD, Natt N, Maraka S, Schmit GD, Eiken PW, Nathan MA, Young WF, Bancos I. Procedural and clinical outcomes of percutaneous adrenal biopsy in a high-risk population for adrenal malignancy. Clin Endocrinol (Oxf) 2016; 85:710-716. [PMID: 27248805 DOI: 10.1111/cen.13117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/30/2016] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The role of percutaneous adrenal biopsy in a high-risk population for adrenal malignancy has not been fully investigated. Our aim was to describe the clinical presentation leading to the adrenal biopsy and evaluate the diagnostic performance, complications and non diagnostic rate of adrenal biopsy. DESIGN Single-centre, retrospective cohort study. PATIENTS AND MEASUREMENTS Medical records of patients who underwent adrenal biopsy between 1994 and 2014 were reviewed. Adrenal biopsy outcome was compared to a predefined reference standard. RESULTS Biopsy was performed in 418 patients [62% men, median age 69 years (range, 15-91)] on 419 adrenal lesions, median size 3·1 cm (range, 0·6-24). The main indication for adrenal mass biopsy was (349/419, 83%) suspected adrenal metastasis from a known or suspected extra-adrenal primary source. Only 116 of 419, 28% of cases had prebiopsy biochemical testing for pheochromocytoma. Biopsy-related complications occurred in 4% of the patients. Histology revealed a metastasis in 231 of 419 (55%), benign adrenal tissue in 137 of 419 (33%), adrenocortical carcinoma in eight of 419 (2%), other lesions in 23 of 419 (5%) including seven cases of pheochromocytoma and six cases of infectious process. Biopsy was nondiagnostic in 20 of 419 (5%). All adrenal masses with unenhanced radiodensity ≤10 HU (42/137, 31%) proved to be benign adrenal adenomas. Adrenal biopsy diagnosed malignancy with a sensitivity of 88·5%, specificity of 91·5%, positive predictive value of 93·4% and negative predictive value of 85·5%. CONCLUSION When used in the appropriate clinical setting, adrenal biopsy is a powerful tool in the diagnostic algorithm of the evaluation of adrenal masses with features suspicious for malignancy. Efforts to increase awareness to perform biochemical testing for pheochromocytoma prior to adrenal biopsy are needed.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Dana Erickson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Neena Natt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A Nathan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
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Maciel CA, Tang YZ, Coniglio G, Sahdev A. Imaging of rare medullary adrenal tumours in adults. Clin Radiol 2016; 71:484-94. [PMID: 26944698 DOI: 10.1016/j.crad.2016.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/14/2015] [Accepted: 01/26/2016] [Indexed: 12/29/2022]
Abstract
Although adrenal medullary tumours are rare, they have important clinical implications. They form a heterogeneous group of tumours, ranging from benign, non-secretory, incidental masses to hormonally active tumours presenting acutely, or malignant tumours with disseminated disease and a poor prognosis. Increasingly, benign masses are incidentally detected due to the widespread use of imaging and routine medical check-ups. This review aims to illustrate the multimodality imaging appearances of rare adrenal medullary tumours, excluding the more common phaeochromocytomas, with clues to the diagnosis and to summarise relevant epidemiological and clinical data. Careful correlation of clinical presentation, hormone profile, and various imaging techniques narrow the differential diagnosis. Image-guided percutaneous adrenal biopsy can provide a definitive diagnosis, allowing for conservative management in selected cases. A close collaboration between the radiologist, endocrinologist, and surgeon is of the utmost importance in the management of these tumours.
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Affiliation(s)
- C A Maciel
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK.
| | - Y Z Tang
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - G Coniglio
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - A Sahdev
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
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Thomas AZ, Blute ML, Seitz C, Habra MA, Karam JA. Management of the Incidental Adrenal Mass. Eur Urol Focus 2016; 1:223-230. [PMID: 28723391 DOI: 10.1016/j.euf.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT Incidentally discovered adrenal masses are becoming more common in clinical practice. OBJECTIVE To review the management of the incidental adrenal mass, including initial evaluation, surveillance, medical therapy, and surgical therapy. EVIDENCE ACQUISITION A literature search of English-language publications that included the keywords adrenal incidentaloma and incidental adrenal mass was performed through July 2015 using PubMed. Relevant original articles and guidelines on the management of the incidental adrenal mass were ultimately selected for analysis, with the consensus of all authors. EVIDENCE SYNTHESIS Data from the manuscripts included in this review were synthesized, and findings were categorized into metabolic evaluation, imaging, biopsy, surgical considerations, and follow-up recommendations. CONCLUSIONS Ideally, management of patients with adrenal incidentalomas should involve a multidisciplinary approach with experienced surgeons, radiologists, and endocrinologists to determine whether such lesions are benign or malignant and functional or nonfunctional and/or whether they require surgical resection. PATIENT SUMMARY Management of patients with adrenal incidentalomas should involve a multidisciplinary approach with surgeons, radiologists, and endocrinologists to determine whether such lesions are benign or malignant and functional or nonfunctional and/or whether they require surgical resection.
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Affiliation(s)
- Arun Z Thomas
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Yoo JY, McCoy KL, Carty SE, Stang MT, Armstrong MJ, Howell GM, Bartlett DL, Tublin ME, Yip L. Adrenal Imaging Features Predict Malignancy Better than Tumor Size. Ann Surg Oncol 2015; 22 Suppl 3:S721-7. [DOI: 10.1245/s10434-015-4684-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Indexed: 12/21/2022]
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Kovach AE, Nucera C, Lam QT, Nguyen A, Dias-Santagata D, Sadow PM. Genomic and immunohistochemical analysis in human adrenal cortical neoplasia reveal beta-catenin mutations as potential prognostic biomarker. Discoveries (Craiova) 2015; 3. [PMID: 26317117 DOI: 10.15190/d.2015.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Evaluation for malignancy of the adrenal cortex, adrenal cortical carcinoma (ACC), is a challenge in surgical pathology due to its relative rarity and histologic overlap with its benign counterpart, adrenocortical adenoma (ACA). We characterized a cohort of human ACC and ACA, including a molecular screen, with a goal of identifying potential diagnostic adjuncts. Thirty-six cases of ACC underwent histologic and clinical review. In the 31 ACC cases with available material and a cohort of 10 ACA cases, a multiplex nucleotide amplification molecular screen from formalin-fixed, paraffin-embedded tissue was peformed. ACCs demonstrated a wide variety of clinical and histologic characteristics with overall poor but unpredictable survival for subjects with ACC. By mutational screen, 12/31 (38.7%) carcinomas harbored CTNNB1 mutations, 1 with an additional TP53 mutation; 1 case each had isolated APC and TP53 mutations; 16 were wild-type for all tested loci; and 1 case demonstrated repeated assay failures. Two of the 10 ACA (20%) demonstrated CTNNB1 mutations by mutational screen, with no additional mutations. Immunohistochemistry for beta-catenin was performed and compared with the results of the molecular screen. Strong nuclear beta-catenin immunopositivity corresponded to the presence of CTNNB1 mutation by genotyping in 10 of 12 cases (83% sensitivity); the mismatched case(s) demonstrated strong membranous staining by immunohistochemistry. Seventeen of the 18 cases without CTNNB1 mutation showed membranous staining or did not stain (94% specificity); the mismatched case demonstrated scattered (<10%) positive nuclei. Both mutations in ACA were corroborated with immunohistochemistry for beta-catenin. No histomorphologic parameter appeared dominant in lesions with a particular mutational status. Based on these results, mutational status of CTNNB1 in adrenal cortical neoplasms can be predicted with reasonable accuracy by immunohistochemical cellular localization. Nuclear localization of beta-catenin by immunostain may be helpful in analysis of select lesions of the adrenal cortex whose biological behavior is uncertain from clinical and histologic information; a larger cohort is required to test this hypothesis.
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Affiliation(s)
- Alexandra E Kovach
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carmelo Nucera
- Laboratory of Human Thyroid Cancers, Preclinical and Translational Research, Division of Cancer Biology and Angiogenesis, Cancer Research Institute (CRI), Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Quynh T Lam
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahnthu Nguyen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Stone WZ, Wymer DC, Canales BK. Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm. J Endourol 2014; 28:104-11. [PMID: 23927734 PMCID: PMC3880901 DOI: 10.1089/end.2013.0380] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. PATIENTS AND METHODS Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. RESULTS Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. CONCLUSIONS Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ≥10 mm with high PET maximum SUV (≥3.1) and SUV ratios (>2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.
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Affiliation(s)
- W. Zachary Stone
- Department of Urology, University of Florida, Gainesville, Florida
| | - David C. Wymer
- Department of Radiology, University of Florida, Gainesville, Florida
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Hartman DJ, Kelly SM, Wiehagen L, Yousem SA. Tissue adequacy for ancillary studies beyond frozen section: a potential method for improving diagnostic and therapeutic results. Int J Surg Pathol 2013; 21:583-6. [PMID: 23999115 DOI: 10.1177/1066896913502224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The evolving nature of medicine has created new challenges in numerous aspects of the practice of pathology. The development of less invasive procedures, the generation of better diagnostic tools, and the recognition of prognostic markers have contributed to these challenges. Between 42.7% and 65.0% of intraoperative consultations are performed to identify or type a neoplastic process. We instituted a reporting requirement on our intraoperative consultations to provide an assessment of adequacy. The assessment of adequacy was subjective by its very nature and was based on the possible uses for the submitted tissue. A total of 3086 intraoperative consultations were performed over a 13-month period. Sixty-two cases were determined to be insufficient for ancillary studies; 52 of these cases were remedied by the surgeon during the original diagnostic procedure. We have instituted a new assessment for intraoperative consultations to optimize the tissue obtained and reduce the need for additional procedures.
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