Amann G, Liegl-Atzwanger B
Klinisches Institut für Pathologie, Medizinische Universität Wien, Währingerstr. 18-20, 1090, Wien, Österreich.
Pathologe. 2012 Sep;33(5):453-8. doi: 10.1007/s00292-012-1606-8.
Due to the multiplicity of localizations and entities, handling of soft tissue tumors is a very challenging subject requiring intensive interdisciplinary collaboration. With respect to the use of intraoperative frozen sections, the following facts are of special relevance: 1) the usual criteria for malignancy, such as infiltrative growth and high mitotic rate are only restrictedly applicable to soft tissue tumors. 2) Correct diagnosis of the tumor entity often requires not only the use of immunohistochemistry but also the identification of genetic alterations by the polymerase chain reaction and/or fluorescence in situ hybridization. In many centres, 14G core biopsies taken from different tumor areas represent the preferred method for a diagnostic biopsy. Apart from cryocollection additional frozen section investigations are used especially in case of open biopsies for quality control of the submitted material or in cases of excision biopsies to ascertain a highly probable radiological diagnosis. The use of intraoperative frozen sections to clarify the resection margins is generally undisputed but should definitely be restricted to centres specialized and experienced in the handling of soft tissue tumors.
由于软组织肿瘤的定位和实体具有多样性,其处理是一个极具挑战性的课题,需要多学科的紧密协作。关于术中冰冻切片的应用,以下事实尤为重要:1)通常用于判断恶性肿瘤的标准,如浸润性生长和高有丝分裂率,在软组织肿瘤中仅具有有限的适用性。2)准确诊断肿瘤实体往往不仅需要使用免疫组织化学,还需要通过聚合酶链反应和/或荧光原位杂交来识别基因改变。在许多中心,从不同肿瘤区域采集的14G核心活检标本是诊断性活检的首选方法。除了冷冻保存外,额外的冰冻切片检查尤其用于开放活检时对送检材料进行质量控制,或在切除活检时以确定高度可能的影像学诊断。术中冰冻切片用于明确切除边缘这一做法总体上并无争议,但绝对应限于在软组织肿瘤处理方面具备专业知识和经验的中心。