术中冰冻切片在指导胰腺导管内乳头状黏液性肿瘤的胰腺切除术范围中的应用：单中心经验及文献复习。

The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms: A Single Institution Experience and Review of the Literature.

机构信息

From the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX.

Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL.

出版信息

Pancreas. 2022 Jan 1;51(1):63-74. doi: 10.1097/MPA.0000000000001963.

DOI:10.1097/MPA.0000000000001963

PMID:35195597

Abstract

OBJECTIVES

The utility of frozen section evaluation of the pancreatic parenchymal resection margin(s) in the surgical management of intraductal papillary mucinous neoplasm (IPMN) remains controversial. We investigated the frequency of its use in IPMN resections and its impact on achievement of negative final parenchymal margin(s).

METHODS

Sixty-two IPMN resections (11 with invasive carcinoma) performed over a 12-year period were studied.

RESULTS

Frozen sections of the parenchymal margin(s) were performed on 44 of the 62 resections (71%), 30 (68%) of which had 10 positive and 22 indefinite margins on frozen section. Additional margin resections were performed in 14 of these 30 cases (47%), boosting the complete resection rate from 14% (2 of 14) on the initial margin(s) to 71% (10 of 14) on the final margin(s) (P = 0.002). Overall, negative final parenchymal margin(s) were achieved more frequently when evaluation of the initial margin(s) by frozen section was performed (35 of 44; 80%) than when it was not (11 of 18; 61%) (P = 0.13).

CONCLUSIONS

In the intraoperative management of IPMN, frozen sections are highly reliable for margin evaluation and are useful for guiding the extent of pancreatic resection.

摘要

目的

胰腺实质切缘（s）的冷冻切片评估在导管内乳头状黏液性肿瘤（IPMN）的外科治疗中的作用仍存在争议。我们调查了其在 IPMN 切除术中的使用频率及其对获得阴性最终实质切缘（s）的影响。

方法

研究了在 12 年期间进行的 62 例 IPMN 切除术（11 例伴有浸润性癌）。

结果

44 例（71%）的 62 例切除术中进行了实质切缘（s）的冷冻切片检查，其中 30 例（68%）在冷冻切片上有 10 个阳性和 22 个不确定的切缘。在这 30 例中的 14 例中进行了额外的边缘切除，将初始切缘（s）的完全切除率从 14%（14 例中的 2 例）提高到最终切缘（s）的 71%（14 例中的 10 例）（P = 0.002）。总体而言，当通过冷冻切片评估初始切缘（s）时，获得阴性最终实质切缘（s）的频率更高（44 例中的 35 例；80%），而不是未评估时（18 例中的 11 例；61%）（P = 0.13）。