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Courtade-Saïdi M, Uro-Coste E, Vergez S, Verillaud B, Pham Dang N, Chabrillac E, Fakhry N, Bigorgne C, Costes-Martineau V. Cytopathological analysis of salivary gland cancer: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:87-91. [PMID: 38052703 DOI: 10.1016/j.anorl.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To determine the indications for fine-needle cytology and the modalities of frozen section pathological analysis in the management of salivary gland cancer. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method. RESULTS Fine-needle cytology is recommended as part of the diagnostic work-up for a major salivary gland tumor suspicious for malignancy. Fine-needle cytology should be performed after MRI to avoid artifacts. Frozen section analysis is recommended to confirm the malignant nature of the tumor, to adapt the extent of resection and to indicate neck dissection. Whenever possible, the entire tumor and adjacent salivary or periglandular tissue should be sent for frozen section analysis. CONCLUSION Fine-needle cytology and frozen section analysis play an essential role in the management of salivary gland cancers.
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Affiliation(s)
- M Courtade-Saïdi
- Département d'anatomie et de cytologie pathologiques, faculté de santé, institut universitaire du cancer Toulouse - Oncopole, université Toulouse III Paul-Sabatier, Toulouse, France
| | - E Uro-Coste
- Département d'anatomie et de cytologie pathologiques, faculté de santé, institut universitaire du cancer Toulouse - Oncopole, université Toulouse III Paul-Sabatier, Toulouse, France
| | - S Vergez
- Département de chirurgie ORL et cervicofaciale, université Toulouse III Paul-Sabatier, CHU de Toulouse-Larrey, Toulouse, France; Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France.
| | - B Verillaud
- Inserm U1141, département d'ORL et de chirurgie cervicofaciale, hôpital Lariboisière, université Paris-Cité, AP-HP, Paris, France
| | - N Pham Dang
- Inserm, Neuro-Dol, service de chirurgie maxillofaciale, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - E Chabrillac
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, Toulouse, France
| | - N Fakhry
- Département d'ORL et chirurgie cervicofaciale, hôpital La Conception, Aix-Marseille université, AP-HM, Marseille, France
| | - C Bigorgne
- Centre de pathologie et d'imagerie, Paris, France
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Lima W, Wang Y, Miyamoto H. The impact of routine frozen section analysis during nephroureterectomy or segmental ureterectomy for urothelial carcinoma on final surgical margin status and long-term oncologic outcome. Urol Oncol 2023:S1078-1439(23)00130-8. [PMID: 37142451 DOI: 10.1016/j.urolonc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/23/2023] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The utility of intraoperative frozen section analysis (FSA) at the surgical margins (SMs) in patients with upper urinary tract cancer has not been established. We herein assessed the clinical significance of routine FSA of ureteral SMs during nephroureterectomy (NU) or segmental ureterectomy (SU). MATERIALS AND METHODS A retrospective review of our Surgical Pathology database identified consecutive patients undergoing NU (n=246) or SU (n=42) for urothelial carcinoma from 2004 to 2018. FSA (n=54) was correlated with the diagnosis of frozen section controls, the status of final SMs, and the prognosis of patients. RESULTS During NU, FSA was performed in 19 (7.7%) patients and was significantly more often requested in cases with ureteral tumor (13.1%) than in those with renal pelvis/calyx tumor (3.5%). Final SMs at the distal ureter/bladder cuff were positive only in non-FSA cases in the entire NU cohort (8.4%; P=0.375) or those with tumor at the lower ureter (57.6%; P=0.046), but not in any of FSA patients (0%). During SU, FSA was performed in 35 (83.3%) cases, including 19 at either proximal or distal SM and 16 at both SMs (SU-FSA2). Final positive SMs were significantly more often detected in non-FSA patients (42.9%) than in all FSA (8.6%; P=0.048) or SU-FSA2 (0%; P=0.020) patients. Overall, FSAs were reported as positive or high-grade carcinoma (n=7), atypical or dysplasia (n=13), and negative (n=34), and all these diagnoses were confirmed accurate on the frozen section controls, except one with a revision from atypical to carcinoma in situ. Meanwhile, 16 (80.0%) of 20 cases with initial positive/atypical FSA achieved negative conversion by excision of additional tissue. Kaplan-Meier analysis revealed that SU-FSA did not significantly reduce the risk of tumor recurrence in the bladder, disease progression, or cancer-specific mortality. Nonetheless, NU-FSA was strongly associated with reduced progression-free (P=0.023) and cancer-specific (P=0.007) survival rates, compared with non-FSA, which may imply a selection bias (e.g., FSA for clinically more aggressive tumors). CONCLUSIONS Performing FSA during NU for lower ureteral tumor, as well as during SU, significantly reduced the risk of positive SMs. However, routine FSA for upper urinary tract cancer failed to considerably improve long-term oncologic outcome.
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Affiliation(s)
- Wilrama Lima
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Ying Wang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY; Department of Urology, University of Rochester Medical Center, Rochester, NY; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
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Kudo W, Kouchi K, Takenouchi A, Matsuoka A, Yabe K, Nakazawa T, Hasegawa A. Recurrent massive bleeding from a small intestinal arteriovenous malformation after surgery for biliary atresia in an infant: a case report and literature review. Surg Case Rep 2021; 7:204. [PMID: 34495444 PMCID: PMC8426411 DOI: 10.1186/s40792-021-01288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Small intestinal arteriovenous malformation (AVM) can cause bleeding. Most small intestinal AVMs occur during adulthood, rarely in infancy. We report a case of an infant with hemorrhage due to small intestinal AVM early and recurrently after Kasai portoenterostomy (PE) for biliary atresia (BA). CASE PRESENTATION A 51-day-old male infant was admitted to our institution for obstructive jaundice. Laparotomic cholangiography revealed BA (IIIb1μ), and Kasai PE was performed at 60 days of age. On postoperative day 17, he developed massive melena and severe anemia. Contrast-enhanced computed tomography (CT) revealed that the jejunum around the PE site was strongly enhanced with enhancing nodules in the arterial phase, and a wide area of the Roux limb wall was slightly enhanced in the venous phase. As melena continued, emergency laparotomy was performed. There were no abnormal macroscopic findings at the PE site except for a clot in the Roux limb 5 cm away from the PE site, and the Roux limb was resected 5 cm. On further investigation, a red spot was detected on the jejunal serosa 30 cm away from the Roux-en-Y anastomosis site. PE and wedge resection for the red spot were performed. Histopathologically, both specimens indicated AVM. He was jaundice-free 65 days after the first surgery. However, at 7 months of age, he developed massive melena again. Contrast-enhanced CT and upper gastrointestinal endoscopy revealed no bleeding lesions. Hemorrhagic scintigraphy showed a slight accumulation at the hepatic hilum prompting an emergency surgery. Intraoperative endoscopy detected a bleeding lesion at the PE site, and the Roux limb was resected (approximately 6 cm). Intraoperative frozen section analysis of the stump of the resected jejunum revealed no abnormal vessels. PE was performed, and permanent section analysis revealed an AVM in the resected jejunum. The postoperative course was uneventful without re-bleeding. CONCLUSIONS We experienced a case of recurrent massive bleeding from small intestinal AVM in an infant after surgery for BA. Intraoperative endoscopy and frozen section analysis helped identify the bleeding lesion and perform a complete resection of the small intestinal AVM, even after surgery, in the infant.
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Affiliation(s)
- Wataru Kudo
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan.
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Atsuko Hasegawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
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Aksoy SÖ, Adiyaman SC, Çevlik AD, Güray Durak M, Seçil M, Sevinç Aİ. Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery. Am J Otolaryngol 2021; 42:102886. [PMID: 33460974 DOI: 10.1016/j.amjoto.2020.102886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE). OBJECTIVE The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis. MATERIAL AND METHODS Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study. RESULTS The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002). CONCLUSION IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.
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Malinova V, von Eckardstein K, Mielke D, Rohde V. Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis. J Neurooncol 2020; 149:315-323. [PMID: 32852725 DOI: 10.1007/s11060-020-03608-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Stereotactic biopsies are routinely used to establish a histological diagnosis of unclear cerebral pathologies. Intraoperatively, frozen-section analysis often confirms diagnostic tissue but also exhibits methodological pitfalls. Intraoperative five-aminolevulinic acid (5-ALA)-fluorescence has been described not only in gliomas but also in other cerebral pathologies. In this study, we assessed the 5-ALA contribution to the intraoperative confirmation of diagnostic tissue in frame-based stereotactic biopsies of unclear intracerebral lesions in direct comparison with frozen-section analysis. METHODS Patients scheduled for stereotactic biopsies of unclear intracerebral pathologies received 5-ALA preoperatively. Obtained samples were intraoperatively analyzed for the presence of 5-ALA-fluorescence. One sample was used for frozen-section and a second one for permanent histopathological analysis. The diagnostic yield of frozen-section and intraoperative 5-ALA-fluorescence was calculated. The inclusion criteria for this retrospective analysis were unclear intracerebral lesions with inconclusive imaging findings and several differential diagnoses. RESULTS A total of 39 patients with 122 obtained specimens were included. The overall diagnostic yield was 92.3%. 5-ALA-positive samples were obtained in 74.3% (29/39) of patients and all these samples contained diagnostic tissue. 5-ALA-fluorescence confirmed diagnostic tissue with a sensitivity of 100%, a specificity of 27%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 100%. A clear diagnosis could be predicted by frozen section with a sensitivity of 80%, a specificity of 100%, a PPV of 100%, and NPV of 30%; Fisher's exact test p = 0.01. CONCLUSION The 5-ALA-fluorescence in stereotactic biopsies of unclear intracerebral pathologies exhibits a high PPV/NPV for intraoperative confirmation of diagnostic tissue and might increase the diagnostic yield of the procedure by overcoming some of the limitations of frozen-section.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Kajetan von Eckardstein
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Karaisli S, Haciyanli M, Gücek Haciyanli S, Tavusbay C, Gur EO, Kamer E, Arikan Etit D. Spindle epithelial tumour with thymus-like differentiation: report of two cases. Ann R Coll Surg Engl 2019; 102:e33-e35. [PMID: 31530165 DOI: 10.1308/rcsann.2019.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.
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Affiliation(s)
- S Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - M Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - S Gücek Haciyanli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - C Tavusbay
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E O Gur
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E Kamer
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - D Arikan Etit
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Papadia A, Morosi C, Wang J, Gasparri ML, Rau T, Ghezzi F, Mueller MD. SLN mapping in early-stage cervical cancer as a minimal-invasive triaging tool for multimodal treatment. Eur J Surg Oncol 2019; 45:679-683. [PMID: 30732972 DOI: 10.1016/j.ejso.2019.01.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To evaluate sensitivity, false negative rate and negative predictive value of the combination of sentinel lymph node (SLN) mapping and frozen section (FS) in triaging cervical cancer patients to a definitive chemo-radiotherapy. METHODS A retrospective analysis of patients with histologically proven cervical cancer undergoing laparoscopic SLN mapping and frozen section of the SLNs followed by a completion radical hysterectomy, pelvic and/or paraarotic lymphadenectomy. Sensitivity, false negative rate and negative predictive value of the SLN mapping, of the frozen section and of the combination of the two in identifying micro- and macrometastases were calculated. RESULTS One-hundred and four patients with cervical cancer underwent surgery. Of these, 87 (83.7%) had bilateral detection rates at the SLN mapping and underwent FS evaluation and were selected for statistical analysis. Twenty-five patients had lymph nodal metastases at H&E staining. Of these, 24 displayed metastatic disease to the SLNs and one to a NSLN accounting for a FN rate of 4.0%. Metastases were identified in 21 patients at the FS analysis. Four patients had metastases in the SLNs that were missed at the FS analysis. The FN rate of the FS is 12.5% if we excluded isolated tumour cells in the analysis. The FN rate of the combined methodology (SLN mapping and FS of the SLN) is 16%. Twenty-one out of 25 patients (84.0%) could correctly be triaged to a definitive chemo-radiotherapy. CONCLUSIONS The combination of SLN mapping and FS of the SLNs is efficient in triaging patients to a definitive chemo-radiotherapy.
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Affiliation(s)
- Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland.
| | - Chiara Morosi
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland; Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Junjie Wang
- Department of Gynaecological Oncology, KK Women's & Children's Hospital, Singapore
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland; Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy
| | - Tilman Rau
- Institute of Pathology, University of Bern, Murtenstrasse 31, Room L310, 3008, Bern, Switzerland
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland
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De Decker K, ter Brugge HG, Bart J, Kruitwagen RF, Nijman HW, Kruse AJ. Borderline tumours of the ovary: Common practice in the Netherlands. Gynecol Oncol Rep 2018; 27:25-30. [PMID: 30581952 PMCID: PMC6297066 DOI: 10.1016/j.gore.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Discordance between frozen section diagnosis and the definite histopathological diagnosis and the fact that the frozen section result is not always unambiguous, may contribute to differences in clinical practice regarding perioperative treatment and follow-up of borderline ovarian tumours (BOTs) patients amongst gynaecologic oncologists, which may lead to over- and undertreatment. The aim of the study was to map the Dutch gynaecologists' preferred treatment and follow-up strategy in case of BOTs. Methods A questionnaire was sent to all Dutch gynaecologists involved in ovarian surgery with perioperative frozen section analysis, and the outcomes were assessed using descriptive statistics. Results Nearly half of the respondents (41.0%) would not perform a staging procedure in case of a BOT. In case of an ambiguous frozen section diagnosis, tending towards invasive carcinoma, a considerable number (sBOT 56.4%; mBOT 30.8%) would perform a lymph node sampling as part of the staging procedure. A relaparotomy/relaparoscopy, to perform a lymph node sampling in case of a serous or mucinous carcinoma after a BOT frozen section diagnosis, would be performed by 97.4% and 48.7% of the respondents, respectively. Conclusions A considerable number of gynaecologists would perform a staging procedure that is recommended for ovarian cancer in case of an ambiguous BOT frozen section diagnosis, especially for serous tumours. In addition, nearly all gynaecologists would perform a second procedure including a lymph node sampling in case of a serous invasive carcinoma after a BOT frozen section diagnosis, which applies to half of the gynaecologists in case of a mucinous carcinoma. In case of an unambiguous frozen section BOT diagnosis, a staging procedure is omitted by nearly half of the gynaecologists. When the frozen section BOT diagnosis is ambiguous, a full ovarian cancer staging procedure is frequently performed. Most gynaecologists perform a second procedure to complete staging when definitive diagnosis shows invasive ovarian cancer. Full staging is performed more frequently in case of serous histopathology, when compared to mucinous tumours.
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Affiliation(s)
- Koen De Decker
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
- Corresponding author at: Isala Clinics, Department of Obstetrics and Gynaecology, PO Box 10400, 8000 GK Zwolle, the Netherlands.
| | - Henk G. ter Brugge
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
| | - Joost Bart
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
| | - Roy F.P.M. Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hans W. Nijman
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
| | - Arnold-Jan Kruse
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
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Mantel HTJ, Westerkamp AC, Sieders E, Peeters PMJG, de Jong KP, Boer MT, de Kleine RH, Gouw ASH, Porte RJ. Intraoperative frozen section analysis of the proximal bile ducts in hilar cholangiocarcinoma is of limited value. Cancer Med 2016; 5:1373-80. [PMID: 27062713 PMCID: PMC4944862 DOI: 10.1002/cam4.693] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/17/2022] Open
Abstract
Frozen section analysis (FS) during cancer surgery is widely used to assess resection margins. However, in hilar cholangiocarcinoma (HCCA), FS may be less reliable because of the specific growth characteristics of the tumor. The aim of this study was to determine the accuracy and consequences of intraoperative FS of the proximal bile duct margins in HCCA. Between 1990 and 2014, 67 patients underwent combined extrahepatic bile duct resection and partial liver resection for HCCA with the use of FS. Sensitivity and specificity of FS was 68% and 97%, respectively. Seventeen of 67 patients (25%) displayed a positive bile duct margin at FS. The false‐negative rate was 16% (eight patients). Ten patients (15%) with a positive bile duct margin underwent an additional resection in an attempt to achieve negative margins, which succeeded in three patients (4%). However, only one of these three patients did not have concomitant lymph node metastases, which are associated with a poor prognosis by itself. The use of FS of the proximal bile duct is of limited clinical value because of the relatively low sensitivity, high risk of false‐negative results, and the low rate of secondary obtained tumor‐free resection margins. Supported by the literature, a new approach to the use of FS in HCCA should be adopted, reserving the technique only for cases in which a substantial additional resection is possible.
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Affiliation(s)
- Hendrik T J Mantel
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrie C Westerkamp
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Egbert Sieders
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M J G Peeters
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke T Boer
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette S H Gouw
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Porte
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van den Akker PAJ, Zusterzeel PLM, Aalders AL, Snijders MPLM, Samlal RAK, Vollebergh JHA, Kluivers KB, Massuger LFAG. Use of risk of malignancy index to indicate frozen section analysis in the surgical care of women with ovarian tumors. Int J Gynaecol Obstet 2016; 133:355-8. [PMID: 26971261 DOI: 10.1016/j.ijgo.2015.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/06/2015] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the importance of the risk of malignancy index (RMI) in the decision to perform frozen section analysis among women with ovarian tumors. METHODS A retrospective study was conducted in 11 centers in the Netherlands. Women who underwent surgical treatment of an ovarian mass with unknown histology between January 2005 and September 2009 were included. The RMI was calculated retrospectively. Frozen section analysis and RMI values were assessed for patients with benign, borderline, and malignant ovarian tumors on final histopathology. RESULTS Overall, 670 women were included. Frozen sections were performed in 323 (48.2%) patients, of whom 206 (63.8%) were diagnosed with benign ovarian tumors, 55 (17.0%) with borderline tumors, and 62 (19.2%) with malignant tumors. Overall, 109 (16.3%) women had an RMI below 20, 106 (97.2%) of whom had benign histology results. Among 235 patients with an RMI over 100, 3 (1.3%) postmenopausal women had malignancies that were missed because frozen sections were not performed. CONCLUSION Women with an RMI below 20 have a low risk of malignancy and therefore do not require frozen section analysis. Postmenopausal women with an RMI greater than 100 should be referred to centers where frozen sections can be performed, and proper facilities and expertise are available to perform staging procedures if necessary.
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Affiliation(s)
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anette L Aalders
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Marc P L M Snijders
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Rahul A K Samlal
- Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Jos H A Vollebergh
- Department of Obstetrics and Gynecology, Bernhoven Hospital, Uden, Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
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Beyer B, Schlomm T, Tennstedt P, Boehm K, Adam M, Schiffmann J, Sauter G, Wittmer C, Steuber T, Graefen M, Huland H, Haese A. A feasible and time-efficient adaptation of NeuroSAFE for da Vinci robot-assisted radical prostatectomy. Eur Urol 2013; 66:138-44. [PMID: 24411279 DOI: 10.1016/j.eururo.2013.12.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The benefit of intraoperative neurovascular structure-adjacent frozen section examination (NeuroSAFE) of the prostate was demonstrated in open radical prostatectomy. In da Vinci robot-assisted prostatectomy (DVP), this approach is often avoided due to suspected difficulties in harvesting the prostate, loss in pneumoperitoneum, increased blood loss, and prolonged operating room (OR) time. OBJECTIVE To provide a detailed description of the technique, feasibility, and impact of the NeuroSAFE technique on OR time, blood loss, frequency of nerve sparing (NS), and positive surgical margins (PSMs) in DVP. DESIGN, SETTING, AND PARTICIPANTS We analyzed 1570 consecutive patients undergoing DVP from 2004 to 2012. NeuroSAFE was performed in 1178 patients. SURGICAL PROCEDURE The prostate was intraoperatively harvested via an extension of the camera trocar incision without undocking the robotic arms. Blood spillage from the dorsal vein complex due to the loss of pneumoperitoneum was avoided by upward traction on the transurethral catheter. After prostate removal, pneumoperitoneum was reestablished by closing the extended incision with running sutures and repositioning the optical trocar. The NeuroSAFE procedure consisted of intraoperative bilateral frozen sections covering the entire neurovascular bundles adjacent prostate surface. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We compared OR time, blood loss, NS frequency, and PSMs in non-NeuroSAFE versus NeuroSAFE DVP. RESULTS AND LIMITATIONS There was no significant difference in blood loss (253.5 ± 204.4 ml vs 265.8 ± 246.7 ml; p=0.49) and OR time (220 min ± 51 vs 224 min ± 64; p=0.22). No complications associated with specimen harvesting occurred. NS rate increased significantly with versus without NeuroSAFE (overall 97% vs 81%; pT2 99% vs 90%, pT3a 94% vs 74%, pT3b 91% vs 30). PSM rate dropped significantly with NeuroSAFE (overall 16% vs 24%; pT2 8% vs 15%, pT3a 22% vs 39%, pT3b 49% vs 67%; all p<0.05). CONCLUSIONS We demonstrate a time-efficient and safe adaption of the NeuroSAFE technique to DVP. PATIENT SUMMARY We describe a feasible and secure adaption of the neurovascular structure-adjacent frozen section examination (NeuroSAFE) procedure for da Vinci robot-assisted prostatectomy. We showed that there was no increased blood loss and operating room time. We maximized the nerve-sparing frequency and could reduce positive surgical margins even in non-organ-confined tumors.
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Affiliation(s)
- Burkhard Beyer
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Katharina Boehm
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Meike Adam
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Jonas Schiffmann
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Guido Sauter
- The Institute of Pathology, University Clinic Eppendorf, Hamburg, Germany
| | - Corina Wittmer
- The Institute of Pathology, University Clinic Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Markus Graefen
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Alexander Haese
- The Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany.
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