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Objective:To investigate the practicality and safety of performing a radical prostatectomy(RP)shortly after the diagnosis of prostate cancer using a combination of prostate targeted biopsy and intraoperative frozen section.Methods:Prospective enrollment was conducted for patients suspected of having prostate cancer based on abnormal prostate specific antigen(PSA)levels.The inclusion criteria for the study were as follows: patients aged 80 years or younger with an ECOG score of 1 or lower.Prior to biopsy, patients underwent both prostate magnetic resonance imaging(MRI)and prostate specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)to determine the likelihood of prostate cancer with clinical stages within T 2-3aN 0M 0.In order to be included in the study, patients must agree to receive RP after their prostate cancer diagnosis has been confirmed by biopsy.All enrolled patients underwent a targeted prostate biopsy, consisting of 1-2 cores.These specimens were then examined through frozen section analysis.For patients diagnosed with prostate cancer through intraoperative frozen section pathology, RP was immediately performed.In this study, transperineal prostate targeted+ systematic biopsy was utilized for patients with undiagnosed prostate cancer.Additionally, routine pathological examination of specimens was conducted.The study analyzed the baseline data, surgical conditions, pathological results, and follow-up information of patients in a descriptive manner. Results:Seven patients, ranging in age from 54 to 77 years with a mean age of 66.7 years, were enrolled in the study.Their mean PSA level was 12.668 μg/L, ranging from 4.359 to 22.195 μg/L.Of these patients, 4 had a PI-RADS score of 4 and 3 had a score of 5.The maximum diameter of the index lesion was 1.3 cm, ranging from 0.5 to 2.2 cm.PSMA PET/CT scores were 4 in 1 case and 5 in 6 cases.The index lesions detected by PSMA PET/CT were consistent with those detected by MRI, and the maximum standardized uptake value(SUVmax)was 15.7, ranging from 5.3 to 39.4.Prostate cancer was diagnosed through targeted biopsy and intraoperative frozen section pathology.Four cases had a Gleason score of 3+ 3=6, while one case had a Gleason score of 3+ 4=7, another had a score of 4+ 3=7, and the last had a score of 4+ 4=8.All patients underwent RP treatment immediately after the prostate cancer diagnosis.Only one patient had slight adhesion at the apex of the prostate, while the other six patients were evaluated by surgeons as having no obvious adhesion at the apex.All surgeries were completed successfully, with a mean operation time of 149.7(ranging from 108 to 255)minutes.After RP, whole mount pathology results indicated that all cases were prostate adenocarcinoma, with a Gleason score of 3+ 4=7 in four cases and 4+ 3=7 in three cases.The pathological stages were pT2 in three cases and pT3a in four cases, with five cases having negative surgical margins and two cases with positive surgical margins.During the study, all patients were monitored for a period of 5.4 months(ranging from 3 to 7 months)and no complications of Clavien Dino≥Ⅰ were observed.PSA levels were measured at 6 weeks and 3 months after surgery, with readings of 0.020 μg/L(ranging from 0 to 0.079 μg/L)and 0.016 μg/L(ranging from 0 to 0.087 μg/L), respectively.No hormonal therapy or radiotherapy was administered during this time.Four patients were able to recover from urinary continence.Conclusions:Based on a combination of MRI and PSMA PET/CT, it is both safe and feasible to promptly perform RP following the diagnosis of prostate cancer through targeted biopsy for index lesions, along with intraoperative frozen section.
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Objective To explore the clinical significance of intraoperative frozen sections for the diagnosis of unexpected gallbladder neoplasm during cholecystectomy for acute cholecystitis.Methods We retrospectively analyzed the clinical data of acute cholecystitis patients who underwent cholecystectomy at the First Affiliated Hospital of Zhengzhou University,from Dec 2012 to Dec 2017.Results In the 1 386 acute cholecystitis patients,19 patients were found to have concurrent gallbladder neoplasm.Surgeons accurately recognized 9 gallbladder neoplasms by general observation alone,including 2 T2 and 2 T3 gallbladder neoplasms,but missed 10 gallbladder neoplasms.At the same time,we found that 3 Tis and 1 T1a gallbladder neoplasms were missed by frozen sections from 10 gallbladder neoplasms diagnosed by definitive histopathological examination.The sensitivity of frozen sections diagnosis was 60％ and the specificity was 100％.Conclusions During cholecystectomy for acute cholecystitis,the accuracy of surgeons' diagnosis with general observation in unexpected gallbladder neoplasm is poor.The accuracy of frozen sections to diagnose advanced gallbladder neoplasm is high,so we advocate frozen sections of every cholecystectomy sample in acute cholecystitis patients.
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Objective Investigate the reasonable surgical approach combined with frozen sections pathological features of papillary thyroid microcarcinoma.Methods Clinical data of 96 cases papillary thyroid microcarcinoma nearly 5 years of follow-up in our clinic referral was retrospectively analyzed.Metastasis and recurrence rate were compared between group of ipsilateral lobe plus isthmus resection (unilateral group) and group of ipsilateral lobe plus isthmus resection and contralateral lobe subtotal (bilateral group).Metastasis and recurrence rate were compared between group of central lymph node dissection (dissection group) and non-dissection group (non-dissection group),and the injury rate of the recurrent laryngeal nerve was also compared between the two groups.Results The diagnosis of cancer by intraoperative frozen pathology were 53 cases (55％).Whether in high or low risk populations,the metastasis and recurrence between unilateral and bilateral groups showed no significant difference (P ＞ 0.05).Whether in high or low risk populations,the metastasis and recurrence between dissection group and non-dissection groups showed no significant difference (P ＞0.05).The temporary injury rate of recurrent laryngeal nerve in dissection group were higher than thatin non-dissection group both in high-risk populations (P =0.040,P ＜ 0.05) and low risk populations(P =0.037,P ＜ 0.05).Conclusions Intraoperative frozen pathological diagnosis of papillary thyroid microcarcinoma is difficult.The reasonable surgical approach for the first time is ipsilateral lobe plus isthmus resection.Preventive cervical dissections operation should not be carried out if the exploratory of lymph node showed no metastasis.
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OBJECTIVE To investigate the frozen section and surgical margin predicting the prognosis of laryngeal carcinoma after partial laryngectomy and decides the circumscription of surgical margin because of the balance between the function of the larynx and the recurrence rate of cancer.METHODS 77 cases of laryngocarcinoma were reviewed in this retrospective study.All of the laryngocarcinoma patients were treated in our hospital during 1996.1～2001.12 frozen section, surgical margin, and pathological section were compared to the recurrence rate of cancer and the survival rate of patients.RESULTS To those Partial laryngectomy whose surgical margin are larger than 0.5 cm, whether carrying out the frozen section is not significant.But to those Partial laryngectomy whose surgical margin are smaller than 0.5 cm, we should carry out the surgical margin to decrease the positive rate of the pathological section.Recurrent rate of the negative group is lower than the positive group(P