Do we need special viewpoints for intraoperative frozen section diagnosis?
Do we need special viewpoints for intraoperative frozen section diagnosis?
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术中冰冻切片诊断需要特殊的观点吗？
DOI：
10.1007/s00428-020-02862-0
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发表时间：
2020
期刊：
影响因子：
3.5
通讯作者：
Arai Tomio
中科院分区：
文献类型：
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作者：
濱崎 慎;木下 義晃;松本 慎二;佐藤 鮎子;辻村 亨;岩崎 昭憲;鍋島 一樹;Arai Tomio
在本期 Virchows Archive 中，Zhu 及其同事根据术中冰冻切片报告了粘性差的胃肠道癌和印戒细胞腺癌的有用形态学特征，以避免误诊 [1]。这些癌在壁内表现出侵袭性生长，并且肿瘤的范围可能无法通过肉眼充分识别。因此，冰冻切片诊断对于确定肿瘤是否已在手术切缘处得到充分切除是必要的。由于在切缘阳性的情况下进行额外切除可以改善预后，因此正确的诊断至关重要。然而，仅使用术中苏木精-伊红 (HE) 染色的标本有时很难进行评估。术中残端冰冻切片诊断在常规组织病理学检查中仅显示有限的肿瘤区域，可能导致假阴性评估。为了避免这种情况，应准备尽可能多的切片。正确的诊断通常很困难，因为与永久切片相比，术中冰冻切片的诊断准确性较低。对于含有大量脂肪的组织来说，制备合适的冰冻切片是很困难的。浆膜下层存在脂肪组织，因此很难获得合适的 HE 染色玻片。然而，粘性差的癌倾向于用纤维间质浸润浆膜下层。通过这样的设计，可以获得能够经受住诊断的样本。从事术中冰冻切片诊断的病理学家应依赖小标本的发现，并根据术前活检结果、肉眼观察、手术发现和临床信息等其他信息来建立诊断。重要的是要意识到
In this issue of Virchows Archiv, Zhu and colleagues report the useful morphologic features of poorly cohesive gastrointestinal carcinoma and signet-ring cell adenocarcinoma based on intraoperative frozen sections to avoid misdiagnosis [1]. These carcinomas show invasive growth within the wall, and the extent of a tumour may not be sufficiently recognised macroscopically. Therefore, frozen section diagnosis is necessary to determine if a tumour has been sufficiently resected at the surgical margin. Since prognosis improves with additional resection in cases of positive margins, correct diagnosis is essential. However, evaluation is sometimes difficult using only intraoperative haematoxylin-eosin (HE)-stained specimens. Intraoperative frozen section diagnosis of stumps shows only a limited tumour area in a conventional histopathological examination, potentially causing a false-negative evaluation. To avoid this, as many sections as possible should be prepared.Correct diagnosis is often difficult because intraoperative frozen sections are less accurate for diagnosis compared to permanent sections. It is difficult to prepare suitable frozen sections for tissues that contain a large amount of fat. Fatty tissue exists in the subserosal layer, making it difficult to acquire appropriate HE-stained slides. However, poorly cohesive carcinoma tends to infiltrate the subserosal layer with fibrous stroma. By devising this, it is possible to obtain a specimen that can withstand diagnosis. Pathologists engaged in intraoperative frozen section diagnosis should rely on small specimen findings and also establish diagnoses based on other information such as preoperative biopsy results, macroscopic findings, surgical findings, and clinical information. It is important to be aware of the