Cioc Adina M, Ellison E Christopher, Proca Daniela M, Lucas Joel G, Frankel Wendy L
Department of Pathology, Ohio State University, Columbus 43210, USA.
Arch Pathol Lab Med. 2002 Oct;126(10):1169-73. doi: 10.5858/2002-126-1169-FSDOPL.
The clinical and radiologic diagnosis of pancreatic cancer and the safety of pancreatic resections have improved. These improvements, together with the indication for resection in some cases of complicated chronic pancreatitis, have reduced the necessity for confirmed preoperative tissue diagnosis. We investigated the clinical use and accuracy of frozen section diagnosis for pancreatic lesions.
We searched archival files for the years 1989-2000 for patients with pancreatic lesions who had received a diagnosis based on frozen section results. We compared the diagnosis of all frozen section slides with that of the permanent sections and reviewed the clinical follow-up notes. We evaluated histologic features useful in differentiating between malignant and benign pancreatic lesions.
A total of 538 patients underwent surgical biopsy and/or resection for suspected pancreatic lesions. Frozen section was requested in 131 cases (284 frozen sections). Ninety cases had frozen section of the pancreatic lesions, 70 cases had frozen section of metastatic sites, and 29 cases had frozen section of surgical margins. Of the 90 cases in which frozen section of the pancreatic lesions was requested, malignancy was diagnosed in 44, a benign lesion was diagnosed in 37, and the diagnosis was atypical and deferred in 9. In total, 3 false-negative frozen sections and 1 false-positive frozen section were identified for respective rates of 1.2% and 0.3%. In all cases in which the frozen section diagnosis was deferred or was inconsistent with the operative impression, and the surgeon acted on his/her impression, the operative diagnoses were subsequently confirmed by additional permanent sections and/or clinical follow-up. The most useful histologic features for the diagnosis of pancreatic adenocarcinoma in frozen sections were variation in nuclear size of at least 4:1, disorganized duct distribution, incomplete duct lumen, and infiltrating single cells.
Frozen sections are useful in conjunction with the impression at surgery for the management of patients with pancreatic lesions. Frozen sections of resection margins were 100% accurate; frozen sections of pancreatic lesions or metastatic sites were accurate in 98.3% of cases. We found an acceptable rate of deferred frozen section (6.6%). The experienced surgeon's impression of malignancy is reliable in cases in which frozen section is deferred or has negative findings.
胰腺癌的临床和影像学诊断以及胰腺切除术的安全性已有所改善。这些改进，连同在某些复杂慢性胰腺炎病例中的切除指征，减少了术前确诊组织诊断的必要性。我们研究了胰腺病变冰冻切片诊断的临床应用及准确性。
我们检索了1989年至2000年的存档文件，查找基于冰冻切片结果进行诊断的胰腺病变患者。我们将所有冰冻切片的诊断与永久切片的诊断进行比较，并查阅临床随访记录。我们评估了有助于区分恶性和良性胰腺病变的组织学特征。
共有538例患者因疑似胰腺病变接受了手术活检和/或切除。131例（284个冰冻切片）病例要求进行冰冻切片检查。90例对胰腺病变进行了冰冻切片检查，70例对转移部位进行了冰冻切片检查，29例对手术切缘进行了冰冻切片检查。在要求对胰腺病变进行冰冻切片检查的90例病例中，44例诊断为恶性，37例诊断为良性病变，9例诊断不典型并延期诊断。总共识别出3例假阴性冰冻切片和1例假阳性冰冻切片，各自的发生率分别为1.2%和0.3%。在所有冰冻切片诊断延期或与手术印象不一致且外科医生根据其印象采取行动的病例中，手术诊断随后通过额外的永久切片和/或临床随访得到证实。冰冻切片中诊断胰腺腺癌最有用的组织学特征是核大小变化至少为4:1、导管分布紊乱、导管腔不完整以及单个细胞浸润。
冰冻切片结合手术时的印象对胰腺病变患者的管理很有用处。手术切缘的冰冻切片诊断准确率为100%；胰腺病变或转移部位的冰冻切片在98.3%的病例中诊断准确。我们发现冰冻切片延期诊断的发生率（6.6%）可以接受。在冰冻切片延期或结果为阴性的病例中，经验丰富的外科医生对恶性病变的判断是可靠的。
