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Ali JP, Mallick BA, Rashid K, Malik UA, Hashmi AA, Zia S, Irfan M, Khan A, Faridi N. Diagnostic accuracy of intraoperative frozen section for margin evaluation of oral cavity squamous cell carcinoma. BMC Res Notes 2024; 17:43. [PMID: 38303028 PMCID: PMC10835936 DOI: 10.1186/s13104-024-06698-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Intraoperative frozen-section evaluation is a valuable technique for detecting positive margins intraoperatively for oral squamous cell carcinoma. We conducted this study to determine the diagnostic accuracy of frozen section in detecting margin status and the effect of tumor grade and stage on diagnostic accuracy. RESULTS A total of 251 biopsy-proven cases of oral squamous cell carcinoma were included in this study. The tissue specimen resected during surgery was sent to the laboratory for frozen section evaluation. The frozen section results were then compared with the permanent section results to determine the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The mean age of the patients included in the study was 51.65 ± 10.03 years, with male predominance (55.4%). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of frozen section were 88.81%, 94.84%, 95.20%, 88.10%, and 91.63%, respectively. We conclude that frozen section is a useful technique in determining the margin status intraoperatively in oral cancers, with high diagnostic accuracy. Moreover, certain clinical parameters such as age, gender, disease duration, and tumor stage and grade appear to affect the diagnostic accuracy of frozen section.
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Affiliation(s)
- Javaria P Ali
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Bakhtawar Allauddin Mallick
- Zainab Panjwani Memorial Hospital, Karachi, Pakistan
- Emergency Medicine, Al-Rayaz Hospital, Karachi, Pakistan
- Prime Cardiology of Nevada, Las Vegas, USA
| | - Khushbakht Rashid
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Shamail Zia
- Department of Pathology, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Biostatistics, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Amir Khan
- Department of Medicine, Kandahar University, Kandahar, Afghanistan.
| | - Naveen Faridi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
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Begum D, Barmon D, Baruah U, Ahmed S, Gupta S, Bassetty KC. Intraoperative frozen section in gynaecology cancers with special reference to ovarian tumours: time to "unfreeze" the pitfalls in the path of the Derby horse of Oncology. J Cancer Res Clin Oncol 2023; 149:9767-9775. [PMID: 37247079 DOI: 10.1007/s00432-023-04866-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE In an oncological set up the role of frozen section biopsy is undeniable. They serve as an important tool for surgeon's intraoperative decision making but the diagnostic reliability of intraoperative frozen section may vary from institute to institute. The surgeon should be well aware of the accuracy of the frozen section reports in their setup to enable them to take decisions based on the report. This is why we had conducted a retrospective study at Dr B. Borooah Cancer Institute, Guwahati, Assam, India to find out our institutional frozen section accuracy. METHODS The study was conducted from 1st January 2017 to 31st December 2022 (5 years). All gynaecology oncology patients who were operated on during the study period and had an intraoperative frozen section done were included in the study. Patients who had incomplete final histopathological report (HPR) or no final HPR were excluded from the study. Frozen section and final histopathology report were compared and analysed and discordant cases were analysed based on the degree of discordancy. RESULTS For benign ovarian disease, the IFS accuracy, sensitivity and specificity are 96.7%, 100% and 93%, respectively. For borderline ovarian disease the IFS accuracy, sensitivity and specificity are 96.7%, 80% and 97.6%, respectively. For malignant ovarian disease the IFS accuracy, sensitivity and specificity are 95.4%, 89.1% and 100%, respectively. Sampling error was the most common cause of discordancy. CONCLUSION Intraoperative frozen section may not have 100% diagnostic accuracy but still it is the running horse of our oncological institute.
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Affiliation(s)
- Dimpy Begum
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Debabrata Barmon
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Upasana Baruah
- Gynaecological Oncology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Shiraj Ahmed
- Oncopathology, Dr B. Borooah Cancer Institute, Guwahati, India
| | - Sakshi Gupta
- Oncopathology, Dr B. Borooah Cancer Institute, Guwahati, India
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Liu Y, Lai F, Lin B, Gu Y, Chen L, Chen G, Xiao H, Luo S, Pang Y, Xiong D, Li B, Peng S, Lv W, Alexander EK, Xiao H. Deep learning to predict cervical lymph node metastasis from intraoperative frozen section of tumour in papillary thyroid carcinoma: a multicentre diagnostic study. EClinicalMedicine 2023; 60:102007. [PMID: 37251623 PMCID: PMC10209138 DOI: 10.1016/j.eclinm.2023.102007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Lymph node metastasis (LNM) assessment in patients with papillary thyroid carcinoma (PTC) is of great value. This study aimed to develop a deep learning model applied to intraoperative frozen section for prediction of LNM in PTC patients. Methods We established a deep-learning model (ThyNet-LNM) with the multiple-instance learning framework to predict LNM using whole slide images (WSIs) from intraoperative frozen sections of PTC. Data for the development and validation of ThyNet-LNM were retrospectively derived from four hospitals from January 2018 to December 2021. The ThyNet-LNM was trained using 1987 WSIs from 1120 patients obtained at the First Affiliated Hospital of Sun Yat-sen University. The ThyNet-LNM was then validated in the independent internal test set (479 WSIs from 280 patients) as well as three external test sets (1335 WSIs from 692 patients). The performance of ThyNet-LNM was further compared with preoperative ultrasound and computed tomography (CT). Findings The area under the receiver operating characteristic curves (AUCs) of ThyNet-LNM were 0.80 (95% CI 0.74-0.84), 0.81 (95% CI 0.77-0.86), 0.76 (95% CI 0.68-0.83), and 0.81 (95% CI 0.75-0.85) in internal test set and three external test sets, respectively. The AUCs of ThyNet-LNM were significantly higher than those of ultrasound and CT or their combination in all four test sets (all P < 0.01). Of 397 clinically node-negative (cN0) patients, the rate of unnecessary lymph node dissection decreased from 56.4% to 14.9% by ThyNet-LNM. Interpretation The ThyNet-LNM showed promising efficacy as a potential novel method in evaluating intraoperative LNM status, providing real-time guidance for decision. Furthermore, this led to a reduction of unnecessary lymph node dissection in cN0 patients. Funding National Natural Science Foundation of China, Guangzhou Science and Technology Project, and Guangxi Medical High-level Key Talents Training "139" Program.
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Affiliation(s)
- Yihao Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Lin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunquan Gu
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Han Xiao
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuli Luo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuyan Pang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dandan Xiong
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiming Lv
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Erik K. Alexander
- Thyroid Section, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Tian S, Cai Y, Tian W. Thoracic splenosis mimicking Castleman's disease: A case report and review of the literature. Asian J Surg 2022; 45:1480-1481. [PMID: 35365392 DOI: 10.1016/j.asjsur.2022.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Surong Tian
- Department of cardiology, the First People's Hospital of Jiangxia District, Wuhan, Hubei Province, 430200, People's Republic of China
| | - Yuxiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Weidong Tian
- Center for Disease Control and Prevention, Jiangxia District of Wuhan, Hubei Province, 430200, People's Republic of China.
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He F, Wang C, Liu W, Shi G. Guiding significance of intraoperative frozen section for range of judging incisal edge of Esophageal Carcinoma. Pak J Med Sci 2021; 37:1499-1503. [PMID: 34475937 PMCID: PMC8377936 DOI: 10.12669/pjms.37.5.3910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore guiding significance of intraoperative frozen section for judging incisal edge range of esophageal carcinoma. Methods: A retrospective descriptive research design was used to collect the clinical and pathological data of 205 patients with esophageal cancer who were treated in Huaihe Hospital of Henan University from March 2012 to July 2015. Among them, 46 patients’ esophageal margins were made into intraoperative frozen sections. Results: In the 205 cases, nine cases were diagnoses with upper incisal edge cancerization, accounting for 4.39%, and five cases were diagnosed with lower incisal edge cancerization, accounting for 2.4%. There were 14 cases in total, accounting for 6.83%. four cases showed positive residual end of intraoperative frozen section. Conclusion: The cancerous focus residue of incisal edge in esophageal carcinoma is not uncommon. Intraoperative frozen section is helpful to judge the proper excision length of esophageal carcinoma.
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Affiliation(s)
- Fei He
- Fei He, Department of Thoracic and Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China. Department of Thoracic and Cardiovascular Surgery, The Huaihe Hospital of Henan University, Kaifeng 475300, Henan, China
| | - Chen Wang
- Chen Wang, Department of Thoracic and Cardiovascular Surgery, The Huaihe Hospital of Henan University, Kaifeng 475300, Henan, China
| | - Weichao Liu
- Weichao Liu, Department of Thoracic and Cardiovascular Surgery, The Huaihe Hospital of Henan University, Kaifeng 475300, Henan, China
| | - Gongning Shi
- Gongning Shi Department of Thoracic and Cardiovascular Surgery, The Huaihe Hospital of Henan University, Kaifeng 475300, Henan, China
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Crippa S, Belfiori G, Tamburrino D, Partelli S, Falconi M. Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground. Updates Surg 2021; 73:1219-1229. [PMID: 34331677 DOI: 10.1007/s13304-021-01141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/26/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
The extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors.
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Affiliation(s)
- Stefano Crippa
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy.,Division of Pancreatic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Belfiori
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy.,Division of Pancreatic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Stefano Partelli
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy.,Division of Pancreatic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Falconi
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy. .,Division of Pancreatic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy. .,Department of Surgery, Division of Pancreatic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Bianchi L, Chessa F, Angiolini A, Cercenelli L, Lodi S, Bortolani B, Molinaroli E, Casablanca C, Droghetti M, Gaudiano C, Mottaran A, Porreca A, Golfieri R, Romagnoli D, Giunchi F, Fiorentino M, Piazza P, Puliatti S, Diciotti S, Marcelli E, Mottrie A, Schiavina R. The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy. Eur Urol 2021; 80:480-488. [PMID: 34332759 DOI: 10.1016/j.eururo.2021.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/17/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. OBJECTIVE To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). DESIGN, SETTING, AND PARTICIPANTS Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. SURGICAL PROCEDURE In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. MEASUREMENTS Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. RESULTS AND LIMITATIONS Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). CONCLUSIONS The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. PATIENT SUMMARY Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna.
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna
| | - Andrea Angiolini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Simone Lodi
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | - Francesca Giunchi
- Pathology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Stefano Puliatti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna
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Kumar AS, Chander V, Parthasarathy J. Diagnostic Accuracy of Intraoperative Frozen Section Analysis in Correlation with Histopathological Diagnosis of Ovarian Tumors in a Tertiary Care Center - A Retrospective Study. Cancer Invest 2020; 39:153-158. [PMID: 33317347 DOI: 10.1080/07357907.2020.1865395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
Treatment plan for ovarian neoplasms differs for benign, borderline and malignant tumors. With a turnaround time of 15-20 minutes, frozen section has become a reliable intraoperative diagnostic tool. The aim of this study is to correlate the frozen section diagnosis with subsequent histopathologic diagnosis and determine the accuracy of frozen section diagnosis. The study included 152 ovarian tumors, the overall accuracy of frozen section in diagnosing malignancy was 99.34%, whereas that for benign and borderline tumors were 97.37% and 96.71% respectively. However, the accuracy, sensitivity and specificity for borderline tumors and mucinous tumors were found to be low.
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Affiliation(s)
- Ac Senthil Kumar
- Department of Surgical Oncology, Saveetha Medical College and Hospital, Chennai, India
| | - Vimal Chander
- Department of Pathology, Saveetha Medical College and Hospital, Chennai, India
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Marinone M, Shrestha E, Thapa A, Tuladar R, Wakefield DB, Chuang L. Surgical management of ovarian tumors without the support of intraoperative pathology readings in Bhaktapur Cancer Hospital. Gynecol Oncol Rep 2020; 33:100589. [PMID: 32577489 DOI: 10.1016/j.gore.2020.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022] Open
Abstract
Intraoperative frozen section plays an important role in surgical management of ovarian masses. Many hospitals in low- and middle-income countries lack this intraoperative pathologic guidance. In this retrospective analysis, we assessed the management of 62 patients who underwent surgical treatment for ovarian masses at Bhaktapur Cancer Hospital in Nepal in light of the final histopathology results. Final histopathology found that 64.5% of the ovarian masses were malignant, 1.0% were borderline, and 30.6% were benign. 55 of the 62 total cases were considered "clinically suspicious" and 52 of the 62 cases underwent hysterectomy and staging procedures in addition to oophorectomy. There was no significant difference in the surgical management or in the postoperative complications when comparing benign, borderline, and malignant masses. Without the support of intraoperative frozen section, benign and malignant masses were treated the same way. The majority of benign cases were overtreated and were exposed to additional risks of postoperative complications. Several malignant cases were undertreated and required additional surgery to appropriately treat and stage malignant ovarian masses. Improved pathology support in Bhaktapur Cancer Hospital would result in better patient outcomes, fewer complications, and avoidance of additional staging surgeries.
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Kumazu Y, Hayashi T, Yoshikawa T, Yamada T, Hara K, Shimoda Y, Nakazono M, Nagasawa S, Shiozawa M, Morinaga S, Rino Y, Masuda M, Ogata T, Oshima T. Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients. BMC Surg 2020; 20:95. [PMID: 32380979 DOI: 10.1186/s12893-020-00744-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cancer cells are often found postoperatively at surgical resection margins (RM) in patients with gastric cancer because of submucosal infiltration or hesitation to secure adequate RM. This study was designed to evaluate risk factors for microscopic positive RM and to clarify which patients should undergo intraoperative frozen section diagnosis (IFSD). Methods Patients who underwent R0/1 gastrectomy for gastric adenocarcinoma between 2000 and 2018 in a single cancer center in Japan were studied. We divided the patients into a positive RM group and negative RM group according to the results of definitive histopathological examinations. We performed multivariate analysis to analyze risk factors for positive RM by and used the identified risk factors to risk stratify the patients. Results A total of 2757 patients were studied, including 49 (1.8%) in the positive RM group. The risk factors significantly associated with positive RM were remnant gastric cancer (odds ratio [OR] 4.7), esophageal invasion (OR 6.3), tumor size ≥80 mm (OR 3.9), and a histopathological diagnosis of undifferentiated type (OR 3.6), macroscopic type 4 (OR 3.7), or pT4 disease (OR 4.6). On risk stratification analysis, the incidence of positive RM was 0.1% without any risk factors, increasing to 0.4% with one risk factor, 3.1% with two risk factors, 5.3% with three risk factors, 21.3% with four risk factors, and 85.7% with five risk factors. Conclusions The risk of macroscopically positive RM increased in patients who have risk factors. IFSD should be performed in patients who have four or more risk factors.
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Lai J, Kresak JL, Cao D, Zhang D, Zhang S, Leon ME, Shenoy A, Liu W, Trevino J, Starostik P, Gonzalo DH, Wang H, Liu X, Fan X. Gastric Plexiform Fibromyxoma: A Great Mimic of Gastrointestinal Stromal Tumor (GIST) and Diagnostic Pitfalls. J Surg Res 2019; 239:76-82. [PMID: 30822694 DOI: 10.1016/j.jss.2019.01.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 08/24/2018] [Revised: 01/10/2019] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Abstract
Through a multicenter study, we collected seven cases of gastric plexiform fibromyxoma including four females and three males, 21 to 79 y old (46.1 ± 10.1). All cases showed a unilocular lesion measuring 0.3 to 17 cm (5.3 ± 2.4), arising from antrum (5/7) or body (2/7). Six of the seven cases had intraoperative frozen sections and/or endoscopic ultrasound fine needle aspiration (EUS-FNA), and all of them were preoperatively or intraoperatively diagnosed as gastrointestinal stromal tumor (GIST). EUS-FNA material showed markedly elongated spindle cells with streaming oval to elongated nuclei with rounded ends. Histologically, the tumors exhibited a plexiform growth pattern and were composed of a rich myxoid stroma and cytologically bland uniform spindle cells without mitotic figures, with the exception of one case which displayed nuclear pleomorphism and increased mitosis. Immunostains showed the tumor cells to be focally positive for SMA (6/6), focally and weakly positive for desmin (3/6) and caldesmon (2/3), negative for CD117 (0/7), CD34 (0/7), DOG1 (0/4), and S100 (0/5). No mutations were identified on Next-Generation Sequencing test, and no loss of SDHB immunoreactivity was identified in the tumor with nuclear pleomorphism. One case was treated with Gleevec because of the initial diagnosis of GIST. All patients had a follow-up for up to 11 y, with no tumor recurrence or metastasis reported. Our results suggest that gastric plexiform fibromyxoma is rare and may be underrecognized and misinterpreted as GIST during intraoperative frozen section or preoperative EUS-FNA diagnosis without immunostains leading to inappropriate treatment.
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Affiliation(s)
- Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Jesse L Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, Missouri
| | - Dongwei Zhang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Sharon Zhang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles (UCLA), California
| | - Marino E Leon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Archana Shenoy
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida; Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, Missouri
| | - Weidong Liu
- Department of Surgery, Xiangya Hospital, XiangYa School of Medicine, Central South University, Changsha, China
| | - Jose Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - David Hernandez Gonzalo
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Hanlin Wang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles (UCLA), California
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Zhang X, Siegelman ES, Lee MK 4th, Tondon R. Pancreatic schwannoma, an extremely rare and challenging entity: Report of two cases and review of literature. Pancreatology 2019; 19:729-37. [PMID: 31153779 DOI: 10.1016/j.pan.2019.05.460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Pancreatic schwannoma is a rare benign tumor, for which the preoperative and intraoperative definitive diagnosis is quite challenging. We present the clinical, radiological and pathologic features of two primary pancreatic schwannomas identified in our pathology database over a period of 30 years at our tertiary care hospital. To better understand the clinico-pathological and radiological features of this entity, we provide a comprehensive review of 73 cases described in the English literature, along with our two cases. This review will especially focus on preoperative and intraoperative diagnosis to assess their accuracy for pancreatic schwannoma. The three most common preoperative diagnoses based on imaging for pancreatic schwannomas were cystic neoplasm (56%), pancreatic neuroendocrine tumor (29%) and mucinous cystic neoplasm (26%). Imaging could not definitely diagnose pancreatic schwannoma in any of the reported cases. To obtain a definite diagnosis before surgery, 25 cases underwent imaging-guided fine-needle aspiration (FNA)/biopsy, of which 60% were correctly reported as benign with definite diagnosis of pancreatic schwannoma in 48%. A higher diagnostic accuracy was observed in biopsies (71%) than FNA (37%). In addition, an intraoperative frozen section was carried out in 15 cases, and 47% were correctly diagnosed. Despite relatively low accuracy, preoperative histological assessment can be helpful in surgical managment. A core tissue specimen is recommended to improve the diagnostic accuracy in this setting.
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Fu J, Ni M, Li H, Li X, Chai W, Zhou Y, Hao L, Chen J. The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors. J Orthop Surg Res 2018; 13:214. [PMID: 30157882 PMCID: PMC6114879 DOI: 10.1186/s13018-018-0885-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background Two-stage revision is the standard procedure for periprosthetic knee infection. But when to perform the second-stage is still under debate. We attempt to search the reliable indicators, risk factors, and proper timing for the second-stage revision. Methods We reviewed and followed 81 infected total knee arthroplasty patients who underwent two-stage revision from January 2010 to January 2014. Our cohort included 56 males and 25 females, all patients were confirmed as PJI with the same phenotypic cultures. The average age was 64.8 ± 8.21 (range 36–78) months. The mean follow-up time was 46.5 ± 17.6 (range 12–72) months after the second-stage surgeries. The diagnostic parameters including serum C-reaction protein, erythrocyte sedimentation rate, and intraoperative frozen section at the time of re-implantation were analyzed. The spacer detention time and antibiotic treatment time were compared. Results Ten of them went through failed first- or second-stage surgeries. The overall success rate was 87.7%. The intraoperative frozen section is a good indicator at the time of re-implantation; the sensitivity and specificity is 90 and 83.1%. Serum CRP and ESR showed poor diagnostic value at time of re-implantation. Atypical pathogen infection, positive FS, and previous sinus were high-risk factors for failure of two-stage revision. Spacer detention time between 12 and 16 weeks had higher success rate than over 16 weeks. Conclusion The proper timing of re-implantation should be combined with disappearance of clinical symptoms and negative intraoperative FS with spacer detention time at 12 to 16 weeks.
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Affiliation(s)
- Jun Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Ming Ni
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Heng Li
- Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xiang Li
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Wei Chai
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Yonggang Zhou
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Libo Hao
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China.
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14
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Lei J, Xu W, Yang W, Xiao J, Huang H, Deng Q, Xu H, Feng L, Tao Q, Zhang S. A faster and simpler way of operation for Meckel's diverticulum: basal ligation combined with intraoperative frozen section. Surg Endosc 2017; 32:1464-1469. [PMID: 28916856 DOI: 10.1007/s00464-017-5833-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The key step in Meckel's diverticulectomy (MD) is to achieve complete resection of MD along with the ectopic epithelium. Currently main treatment methods for Meckel's diverticulum are either intestinal resection and anastomosis or wedge resection. Here we introduced a new method to treat MD. The goal of this study was to investigate the clinical effects and advantages of a new operation method for Meckel's diverticulum: basal ligation combined with intraoperative frozen section. METHODS 262 cases of Meckel's diverticulum were resected with simple basal ligation operation. Intraoperative frozen pathological section was performed to determine surgery strategies. Based on the existence of basal residual ectopic mucosa, surgery was either terminated or further wedge intestinal resection or bowel resection was performed. RESULTS All 262 surgeries were successfully completed. Additional wedge resection or bowel resection was performed in only 23 of them due to the presence of ectopic basal residual gastric mucosa. No ectopic mucosa was found for the other cases, and the operation ended after basal ligation. All patients had no complications such as intestinal fistula, bleeding for 6 months-7.6 years after surgery. CONCLUSIONS Intraoperative frozen pathological examination can well determine whether ectopic Meckel's diverticulum mucosa locates at the basal part. Basal ligation is a safe and effective operation method, and it can significantly shorten the operation time and postoperative fasting time.
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Affiliation(s)
- Jun Lei
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Wei Xu
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Wenping Yang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - Juhua Xiao
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, China
| | - Hui Huang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - QingQiang Deng
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Hongyan Xu
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - Liang Feng
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Qiang Tao
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Shouhua Zhang
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China.
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Bissolati M, Desio M, Rosa F, Rausei S, Marrelli D, Baiocchi GL, De Manzoni G, Chiari D, Guarneri G, Pacelli F, De Franco L, Molfino S, Cipollari C, Orsenigo E. Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer 2017; 20:70-82. [PMID: 26732876 DOI: 10.1007/s10120-015-0589-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. METHODS We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). RESULTS One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. CONCLUSIONS Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.
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Jorns JM, Daignault S, Sabel MS, Wu AJ. Is intraoperative frozen section analysis of reexcision specimens of value in preventing reoperation in breast-conserving therapy? Am J Clin Pathol 2014; 142:601-8. [PMID: 25319974 DOI: 10.1309/ajcprsoa2g8rlexy] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 10/24/2022] Open
Abstract
OBJECTIVES A prior study at our institution showed a marked reduction in reoperation for margin reexcision following the development of an intraoperative frozen section evaluation of margins (FSM) practice on lumpectomy specimens from patients undergoing breast-conserving therapy (BCT). This study aimed to examine the frequency of FSM utilization, FSM pathology performance, and outcomes for BCT patients undergoing margin reexcision only. METHODS Consecutive reexcision-only specimens were reviewed from a 40-month period following the development of the FSM practice. Clinicopathologic features and patient outcomes were assessed. RESULTS FSM was performed in 46 (30.7%) of 150 reexcision-only operations. Of the 46 operations with FSM, there were 28 (60.9%) true-negative, 12 (26.1%) true-positive, six (13.0%) false-negative, and no false-positive cases. There was no difference in further reexcision, total operations, or conversion to mastectomy among patients with and without FSM. Need for further reexcision was significantly associated with tumor multifocality (P = .008). CONCLUSIONS Despite overall good pathology performance for FSM in reexcision-only specimens, use of FSM did not affect patient outcome. Rather, underlying disease biology appeared most significant in predicting whether adequate surgical margins could be attained.
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Affiliation(s)
- Julie M. Jorns
- Department of Pathology, University of Michigan, Ann Arbor
| | - Stephanie Daignault
- Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | | | - Angela J. Wu
- Department of Pathology, University of Michigan, Ann Arbor
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Ribback S, Flessa S, Gromoll-Bergmann K, Evert M, Dombrowski F. Virtual slide telepathology with scanner systems for intraoperative frozen-section consultation. Pathol Res Pract 2014; 210:377-82. [PMID: 24674453 DOI: 10.1016/j.prp.2014.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/24/2014] [Indexed: 11/18/2022]
Abstract
Telepathology provides pathology services over a distance using digital imaging and telecommunication for primary diagnostic practice, including intraoperative frozen sections. Virtual slide technology provides digitizing of histological slides by scanner systems and improved remote assessment substantially. In this retrospective study, diagnostic accuracy of intraoperative frozen sections assessed as virtual slide was determined. Tissue assessment was mainly requested for urological, gynecological and dermatological resections. Issues of time consumption, cost and cost effectiveness of this diagnostic method are discussed. 1204 intraoperative frozen sections were conducted in the course of this study at our department over a period of 2.5 years. 98.59% of all intraoperative frozen sections were accurately diagnosed in the initial telepathological assessment. Tumor affection was present in 15.6% of frozen sections, in 174 instances already assessed in the initial slides (sensitivity 92.6%). Discrepant diagnoses compared to the final diagnosis occurred in 1.41%. Our determined averaged time for virtual slide technology of 10.58±8.19min can be ranged in well. Our study did not allow a full economic assessment, but some preliminary insights are pointed out. The quality of services is highly acceptable and the investment costs and the labor cost of virtual slide technology are lower than those of robotic microscopy.
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Affiliation(s)
- Silvia Ribback
- Institut für Pathologie, Universitätsmedizin Greifswald, Germany.
| | - Steffen Flessa
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Ernst-Moritz-Arndt-Universität Greifswald, Germany
| | | | - Matthias Evert
- Institut für Pathologie, Universitätsmedizin Greifswald, Germany
| | - Frank Dombrowski
- Institut für Pathologie, Universitätsmedizin Greifswald, Germany
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Ballehaninna UK, Chamberlain RS. Utility of intraoperative frozen section examination of sentinel lymph nodes in ductal carcinoma in situ of the breast. Clin Breast Cancer 2013; 13:350-8. [PMID: 23791128 DOI: 10.1016/j.clbc.2013.02.013] [Citation(s) in RCA: 4] [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: 10/15/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intraoperative frozen section (IFS) examination of sentinel lymph nodes (SLN) is useful in selecting patients with invasive breast cancer for immediate axillary lymph node dissection. However, whether IFS evaluation of the SLNs in ductal carcinoma in situ (DCIS) of the breast has any value has not been previously assessed. METHODS Clinicopathologic data from patients with DCIS who underwent resection with SLN biopsy (2004-2010) were collected to assess the sensitivity, specificity, and accuracy of IFS, and its impact on axillary management. RESULTS A total of 267 patients with DCIS underwent resection with SLN biopsy and IFS evaluation. Preoperative pathology was DCIS (n = 231), DCIS with microinvasion (n = 24), and DCIS with other lesions (n = 12). Fifty-two (19.5%) patients had invasive breast cancer on final pathology. SLN metastases were identified in 13 (4.8%) patients; however, only 4 (1.5%) were IFS positive. IFS examination was negative in 263 (98.5%) patients. Among patients with SLN metastases, the most common pattern of metastases was either micrometastasis (n = 6) or immunohistochemistry-positive individual tumor cells (n = 4), whereas 3 patients had a macrometastasis. IFS examination was falsely negative in 9 of these 13 patients for a false-negative rate of 69.3%, and a sensitivity and specificity of 31% and 100% respectively. Nine of the 13 patients underwent axillary lymph node dissection and only 1 patient had further axillary metastasis. CONCLUSIONS SLN metastases in DCIS is rare and most commonly involves SLN micrometastasis or immunohistochemistry-positive individual tumor cells. SLN IFS evaluation in DCIS has a low yield and sensitivity, and can be safely omitted to reduce operative duration and cost.
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Affiliation(s)
- Umashankar K Ballehaninna
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ; Department of Surgery, Maimonides Medical Center, Brooklyn, NY
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