Diagnostic Accuracy and Usefulness of Intraoperative Margin Assessment by Frozen Section in Gastric Cancer
Diagnostic Accuracy and Usefulness of Intraoperative Margin Assessment by Frozen Section in Gastric Cancer
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DOI：
10.1245/s10434-019-07302-1
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发表时间：
2019-06-01
影响因子：
3.7
通讯作者：
Katai, Hitoshi
中科院分区：
文献类型：
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作者：
Nakanishi, Koki;Morita, Shinji;Katai, Hitoshi
背景术中冰冻检查对肿瘤手术切缘阴性的确认具有重要的临床意义。我们通过研究1115例在我院治疗的胃癌标本，调查了冷冻切片评估的诊断准确性和阳性切除边缘的危险因素。方法回顾性分析了2000年至2017年在我院接受术中边缘评估的胃癌患者的结果，采用冷冻检查，并对治疗意图进行了回顾性分析。将冷冻切片评估与相应的永久切片评估进行比较，以评价前者的准确性、灵敏度和特异性。检查了两次评估之间不一致的原因。此外，与阳性margins.ResultsIn总，1241标本从1115例患者相关的风险因素。冷冻切片评估的准确性、敏感性和特异性分别为99.4%、99.5%和97.8%。有8个不一致的病例。2例假阴性病例在最终病理诊断后因漏诊肿瘤细胞而需再次行胃切除术。6例假阳性病例由于假阳性结果而进行了不必要的额外切除。在我们的冷冻系列中，89例在永久切片上有阳性边缘。多因素回归分析阳性手术切缘的患者显示大直径（50毫米）和T4肿瘤是独立的危险factors.ConclusionsIntraoperative冷冻检查是一个高度准确的方法，是有用的实现负利润率。对于肿瘤最大直径大于50 mm或有浆膜浸润的患者，尤其推荐使用此方法来确认阴性切缘。
BackgroundIntraoperative frozen examination is clinically important for negative margin confirmation in cancer surgery. We investigated the diagnostic accuracy of frozen-section assessment and risk factors for positive resection margins by studying gastric cancer specimens from 1115 patients treated at our hospital.MethodsThe results of gastric cancer patients who had undergone intraoperative margin assessment, employing frozen examination, with curative intent in our unit between 2000 and 2017 were retrospectively analyzed. Frozen section assessments were compared with the corresponding permanent section assessments to evaluate the accuracy, sensitivity, and specificity of the former. The causes of discordances between two assessments were examined. In addition, risk factors associated with positive margins were identified.ResultsIn total, 1241 specimens were obtained from the 1115 patients. The accuracy, sensitivity, and specificity of frozen-section assessments were 99.4%, 99.5%, and 97.8%, respectively. There were eight discordant cases. Two false-negative cases required another gastrectomy after final pathological diagnosis because of missed neoplastic cells. Six false-positive cases underwent unnecessary additional resection due to false positive results. In our frozen series, 89 cases had a positive margin on permanent section. Multivariate regression analysis of patients with positive surgical margins revealed large diameter (50mm) and T4 tumor to be independent risk factors.ConclusionsIntraoperative frozen examination is a highly accurate method that is useful for achieving negative margins. This procedure is especially recommended for patients with a tumor larger than 50mm in maximum diameter or serosal invasion to confirm a negative margin.