Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Surg Endosc. 2023 Sep;37(9):6736-6748. doi: 10.1007/s00464-023-10100-2. Epub 2023 May 22.
Accurate diagnosis of the lateral extent of early gastric cancer during endoscopic submucosal dissection (ESD) is crucial to achieve negative resection margins. Similar to intraoperative consultation with a frozen section in surgery, rapid frozen section diagnosis with endoscopic forceps biopsy may be useful in assessing tumor margins during ESD. This study aimed to evaluate the diagnostic accuracy of frozen section biopsy.
We prospectively enrolled 32 patients undergoing ESD for early gastric cancer. Biopsy samples for the frozen sections were randomly collected from fresh resected ESD specimens before formalin fixation. Two different pathologists independently diagnosed 130 frozen sections as "neoplasia," "negative for neoplasia," or "indefinite for neoplasia," and the frozen section diagnosis was compared with the final pathological results of the ESD specimens.
Among the 130 frozen sections, 35 were from cancerous areas, and 95 were from non-cancerous areas. The diagnostic accuracies of the frozen section biopsies by the two pathologists were 98.5 and 94.6%, respectively. Cohen's kappa coefficient of diagnoses by the two pathologists was 0.851 (95% confidence interval: 0.837-0.864). Incorrect diagnoses resulted from freezing artifacts, a small volume of tissue, inflammation, the presence of well-differentiated adenocarcinoma with mild nuclear atypia, and/or tissue damage during ESD.
Pathological diagnosis of frozen section biopsy is reliable and can be applied as a rapid frozen section diagnosis for evaluating the lateral margins of early gastric cancer during ESD.
在内镜黏膜下剥离术（ESD）中准确诊断早期胃癌的侧向范围对于实现阴性切缘至关重要。类似于手术中与冰冻切片的术中咨询，内镜活检的快速冰冻切片诊断可能有助于评估 ESD 期间肿瘤边缘。本研究旨在评估冰冻切片活检的诊断准确性。
我们前瞻性地招募了 32 名接受 ESD 治疗的早期胃癌患者。在正式固定福尔马林之前，从新鲜切除的 ESD 标本中随机采集活检样本进行冰冻切片。两名不同的病理学家独立诊断了 130 个冰冻切片为“肿瘤”、“非肿瘤”或“肿瘤不确定”，并将冰冻切片诊断与 ESD 标本的最终病理结果进行比较。
在 130 个冰冻切片中，35 个来自癌性区域，95 个来自非癌性区域。两名病理学家的冰冻切片诊断准确率分别为 98.5%和 94.6%。两名病理学家的诊断 Cohen's kappa 系数为 0.851（95%置信区间：0.837-0.864）。错误的诊断结果是由于冷冻伪影、组织体积小、炎症、存在分化良好的具有轻度核异型性的腺癌和/或 ESD 期间的组织损伤所致。
冰冻切片的病理诊断是可靠的，可以作为一种快速的冰冻切片诊断方法，用于评估 ESD 期间早期胃癌的侧向边缘。
