Yamaguchi K, Chijiiwa K, Saiki S, Shimizu S, Tsuneyoshi M, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
J Surg Oncol. 1997 Jun;65(2):132-6. doi: 10.1002/(sici)1096-9098(199706)65:2<132::aid-jso11>3.0.co;2-7.
An accurate frozen section diagnosis is important when deciding the surgical strategy against a gallbladder tumor intraoperatively. Little has been reported on the accuracy of frozen section diagnosis of the gallbladder.
In a total of 86 consecutive patients with gallbladder tumor, the accuracy of the frozen section diagnosis was examined. There were 32 patients with polypoid lesions and 54 with nonpolypoid tumors.
The frozen tissue diagnosis and final diagnosis were identical in 82 of the 86 cases, that is, benign in 65 and malignant in 17. The other four cases had different diagnoses, that is, conversion from benign to malignant in two and from malignant to benign in two. The overall accuracy of frozen diagnosis was 95.3% (97.0% for benign and 94.7% for malignant). In 32 polypoid lesions, the accuracy of frozen section diagnosis was 91% (93% for benign; 89% for malignant). In 54 nonpolypoid lesions, the accuracy of diagnosis was 98% (100% for benign; 93% for malignant). The diagnosis of depth of invasion was identical only in 7 (70%) of the 10 carcinoma cases examined, while it was diverse in the remaining 3, that is, conversion from adenocarcinoma invading the subserosa to that limiting to the mucosa in one, from carcinoma within the mucosa to that infiltrating the muscle coat in one, and from carcinoma affecting the muscle layer to that invading the subserosa in the other. Alterations of frozen section diagnosis about being benign or malignant and about the depth of invasion were encountered in seven patients, five of whom had a polypoid tumor.
The intraoperative frozen tissue diagnosis is fairly reliable as to whether lesions are malignant or benign; however, accuracy is low in patients with polypoid lesions of the gallbladder. Also, frozen section diagnosis does not reliably measure the depth of invasion of gallbladder carcinoma.
术中决定针对胆囊肿瘤的手术策略时，准确的冰冻切片诊断很重要。关于胆囊冰冻切片诊断的准确性，此前报道较少。
对连续86例胆囊肿瘤患者的冰冻切片诊断准确性进行了检查。其中有32例息肉样病变患者和54例非息肉样肿瘤患者。
86例中有82例冰冻组织诊断与最终诊断一致，即65例为良性，17例为恶性。另外4例诊断不同，即2例从良性转变为恶性，2例从恶性转变为良性。冰冻诊断的总体准确率为95.3%（良性为97.0%，恶性为94.7%）。在32例息肉样病变中，冰冻切片诊断的准确率为91%（良性为93%；恶性为89%）。在54例非息肉样病变中，诊断准确率为98%（良性为100%；恶性为93%）。在所检查的10例癌病例中，仅7例（70%）的浸润深度诊断一致，其余3例不同，即1例从侵犯浆膜下层的腺癌转变为局限于黏膜层的腺癌，1例从黏膜内癌转变为浸润肌层的癌，另1例从累及肌层的癌转变为侵犯浆膜下层的癌。7例患者出现了冰冻切片诊断在良恶性及浸润深度方面的改变，其中5例患有息肉样肿瘤。
术中冰冻组织诊断对于病变是恶性还是良性相当可靠；然而，胆囊息肉样病变患者的诊断准确率较低。此外，冰冻切片诊断不能可靠地测量胆囊癌的浸润深度。
