Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.
Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan.
Ann Surg Oncol. 2019 Jun;26(6):1787-1794. doi: 10.1245/s10434-019-07302-1. Epub 2019 Mar 14.
Intraoperative frozen examination is clinically important for negative margin confirmation in cancer surgery. We investigated the diagnostic accuracy of frozen-section assessment and risk factors for positive resection margins by studying gastric cancer specimens from 1115 patients treated at our hospital.
The results of gastric cancer patients who had undergone intraoperative margin assessment, employing frozen examination, with curative intent in our unit between 2000 and 2017 were retrospectively analyzed. Frozen section assessments were compared with the corresponding permanent section assessments to evaluate the accuracy, sensitivity, and specificity of the former. The causes of discordances between two assessments were examined. In addition, risk factors associated with positive margins were identified.
In total, 1241 specimens were obtained from the 1115 patients. The accuracy, sensitivity, and specificity of frozen-section assessments were 99.4%, 99.5%, and 97.8%, respectively. There were eight discordant cases. Two false-negative cases required another gastrectomy after final pathological diagnosis because of missed neoplastic cells. Six false-positive cases underwent unnecessary additional resection due to false positive results. In our frozen series, 89 cases had a positive margin on permanent section. Multivariate regression analysis of patients with positive surgical margins revealed large diameter (≥ 50 mm) and T4 tumor to be independent risk factors.
Intraoperative frozen examination is a highly accurate method that is useful for achieving negative margins. This procedure is especially recommended for patients with a tumor larger than 50 mm in maximum diameter or serosal invasion to confirm a negative margin.
术中冰冻检查对癌症手术的阴性切缘确认具有重要的临床意义。我们通过研究我院 1115 例接受治疗的胃癌标本，调查了冰冻切片评估的诊断准确性和阳性切缘的危险因素。
回顾性分析了 2000 年至 2017 年期间我院采用术中边缘评估（冰冻检查）进行根治性治疗的胃癌患者的结果。将冰冻切片评估与相应的永久切片评估进行比较，以评估前者的准确性、敏感性和特异性。检查两种评估之间的差异原因。此外，还确定了与阳性边缘相关的危险因素。
共有 1115 例患者获得 1241 个标本。冰冻切片评估的准确性、敏感性和特异性分别为 99.4%、99.5%和 97.8%。有 8 个不一致的病例。由于错过肿瘤细胞，两个假阴性病例在最终病理诊断后需要再次进行胃切除术。由于假阳性结果，六个假阳性病例进行了不必要的额外切除。在我们的冰冻系列中，89 例永久切片上有阳性边缘。对阳性手术边缘患者的多变量回归分析显示，大直径（≥50mm）和 T4 肿瘤是独立的危险因素。
术中冰冻检查是一种高度准确的方法，有助于实现阴性切缘。对于最大直径大于 50mm 或浆膜侵犯的患者，建议采用该程序以确认阴性切缘。
