From the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus.
Arch Pathol Lab Med. 2022 Jan 1;146(1):84-91. doi: 10.5858/arpa.2020-0483-OA.
CONTEXT.—: Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Surgery remains the mainstay of treatment, and frozen section analysis is used to confirm diagnosis and determine resectability and margin status.
OBJECTIVE.—: To evaluate use and accuracy of frozen section and how diagnosis impacts surgical procedure.
DESIGN.—: We reviewed patients with planned pancreatic resections between January 2014 and March 2019 with at least 1 frozen section. Pathology reports including frozen sections, preoperative cytology, and operative notes were reviewed. Frozen sections were categorized by margin, primary pancreatic diagnosis, metastasis, or vascular resectability. The deferral and error rates and surgeons' response were noted.
RESULTS.—: We identified 898 planned pancreatic resections and 221 frozen sections that were performed on 152 cases for 102 margins, 94 metastatic lesions, 20 primary diagnoses, and 5 to confirm vascular resectability. The diagnosis was deferred to permanent sections in 13 of 152 cases (8.6%) on 16 of 221 frozen sections (7.2%): 6 for metastasis, 8 for margins, and 2 for primary diagnosis. Discrepancies/errors were identified in 4 of 152 cases (2.6%) and 4 of 221 frozen sections (1.8%). Surgeons' responses were different than expected in 8 of 221 frozen sections (3.6%), but their actions were explained by other intraoperative findings in 6 of 8.
CONCLUSIONS.—: Frozen section remains an important diagnostic tool used primarily for evaluation of margins and metastasis during pancreatectomy. In most cases, a definitive diagnosis is rendered, with occasional deferrals and few errors. Intraoperative findings explain most cases where surgeons act differently than expected based on frozen section diagnosis.
在美国，胰腺癌是导致癌症死亡的第三大原因。手术仍然是主要的治疗方法，而冷冻切片分析用于确认诊断并确定可切除性和切缘状态。
评估冷冻切片的使用情况和准确性，以及诊断如何影响手术程序。
我们回顾了 2014 年 1 月至 2019 年 3 月期间计划进行胰腺切除术且至少有 1 个冷冻切片的患者。对包括冷冻切片、术前细胞学和手术记录在内的病理报告进行了审查。将冷冻切片按边缘、原发性胰腺诊断、转移或血管可切除性进行分类。记录了延迟率和错误率以及外科医生的反应。
我们确定了 898 例计划进行的胰腺切除术和 221 例冷冻切片，对 152 例患者的 102 个边缘、94 个转移性病变、20 个原发性诊断和 5 个确认血管可切除性进行了检测。在 152 例患者中有 13 例（8.6%）的 16 个冷冻切片（7.2%）的诊断被推迟到石蜡切片，其中 6 例为转移，8 例为边缘，2 例为原发性诊断。在 152 例患者中有 4 例（2.6%）和 221 例冷冻切片中有 4 例（1.8%）出现了差异/错误。在 221 例冷冻切片中有 8 例（3.6%）外科医生的反应与预期不符，但在这 6 例中，他们的行动是由其他术中发现解释的。
冷冻切片仍然是一种重要的诊断工具，主要用于评估胰腺切除术中的边缘和转移。在大多数情况下，都会做出明确的诊断，偶尔会有延迟，错误也很少。大多数情况下，外科医生的行动与基于冷冻切片诊断的预期不符，这可以通过术中发现来解释。
