Oncologic outcomes of microscopic tumor cut-through in locally advanced oral squamous cell carcinoma

Introduction: The gold standard treatment of oral cavity squamous cell carcinoma (OCSCC) is surgical resection; however, standardization of the margins and the role of frozen section are still debatable. Microscopic tumor cut-thought (MTCT) occurs when the surgeon has an initial positive frozen section margin that is cleared with further resection to negative. Objective: This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods: A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results: We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR 2.205; 95% CI 1.243 ­ 3.914; p=0.007) and multivariate (HR 1.851; 95% CI 1.285 ­ 2.666; p=0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ 1.669; 95% CI 1.056 ­ 2.635; p=0.028) and multivariate (HZ 1.307; 95% CI 0.816 ­ 2.092; p=0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion: Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

Comparison of four blocking methods for eliminating autofluorescence of mouse liver frozen sections / 第二军医大学学报

Objective To compare different blocking methods for eliminating autofluorescence of mouse liver frozen sections, so as to find the best method to reduce the interference to immunofluorescence positive signals and improve the accuracy of immunofluorescence. Methods Intrasplenic injection-liver colonization nude mice: Hepa1-6-GFP cells were intrasplenically injected into male athymic BALB/c nude mice to create liver colonization models. Liver tissues were frozen and continuously sectioned. Sections were blocked with AB reagent (A reagent: streptavidin reagent, B reagent: biotin reagent), blocking buffer, AB reagent＋blocking buffer, or acetone＋AB reagent＋blocking buffer, and then the autofluorescence of the frozen sections was detected. C57BL/6 mice: the liver tissues of C57BL/6 mice were frozen and continuously sectioned, and then the sections were blocked with AB reagent, blocking buffer, AB reagent＋blocking buffer, or acetone＋AB reagent＋blocking buffer. Liver macrophages (Kupffer cells) were labeled with F4/80, and then the autofluorescence of mouse liver frozen sections was detected. Results In the immunofluorescence staining of liver tissue frozen sections, all the above four blocking methods could reduce the autofluorescence of liver sections, and acetone＋AB reagent＋blocking buffer group had the best effect. Conclusion The combined buffers (acetone＋AB reagent＋blocking buffer) has the best effect in eliminating the autofluorescence of mouse liver frozen section.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer / O papel da imagem de banda estreita intraoperatória na microcirurgia transoral a laser para câncer glótico inicial e moderadamente avançado

Abstract Introduction: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. Objective: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Methods: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Results: Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. Conclusion: The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

Resumo Introdução: A microcirurgia transoral a laser é uma técnica bem estabelecida para o tratamento de câncer de laringe inicial e moderadamente avançado. Objetivo: Verificar a utilidade da imagem de banda estreita na avaliação intraoperatória da mucosa laríngea na especificação das margens cirúrgicas. Método: Foram avaliados 44 cânceres glóticos T1-T2 consecutivos, tratados com cordectomia Tipo I-VI, por microcirurgia transoral a laser. As áreas suspeitas (90 amostras/44 pacientes) foram submetidas a biopsia e avaliadas através de imagens de banda estreita e luz branca e enviadas para cortes por congelação. Resultados: Nosso estudo revelou que 75 (83,3%) das 90 amostras apresentaram histopatologia positiva na análise com luz branca e imagens de banda estreita: 30 (40%) foram confirmadas como carcinoma in situ ou carcinoma invasivo e 45 (60%) como displasia moderada a grave. Em seis pacientes, a mucosa apresentou-se suspeita apenas na imagem de banda estreita, sem suspeita sob luz branca. Assim, nesses seis pacientes 18/90 (20%) amostras foram colhidas. Em 5/6 pacientes, 16/18 (88,8%) amostras mostraram resultado positivo na análise de congelação: em 6/18 (33,3%) amostras foi confirmado carcinoma (dois pacientes) e em 10/18 (66,6%) foi confirmada displasia grave (três pacientes). Em um paciente, 2/18 (11,1%) as amostras mostraram resultado negativo na congelação. A análise apresentada mostrou que a sensibilidade, a especificidade e a acurácia da luz branca foram de 79,5%, 20% e 71,1%, respectivamente, enquanto a imagem de banda estreita apresentou como resultados 100%, 0,0% e 85,7%, respectivamente. Conclusão: O uso intraoperatório de imagem de banda estreita provou ser valioso na identificação de áreas suspeitas da mucosa, confirmou as suspeitas verificadas na análise com luz branca e, o que é mais importante, identificou microlesões além do alcance da luz branca.

Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis

BACKGROUND: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.

Is the frozen section examination for sentinel lymph node necessary in early breast cancer patients?

PURPOSE: Sentinel lymph node (SLN) biopsy (SLNB) is widely performed for axillary staging in patients with breast cancer. Based on the results of frozen section examination (FSE), surgeons can decide to continue further axillary dissections. This study aimed to verify the accuracy of FSE for SLNs. METHODS: We reviewed the records of 4,219 patients who underwent SLNB for primary invasive breast cancer between 2007 and 2016 at the Severance Hospital. We evaluated factors associated with the false-negative results of FSE for SLNs using the Generalized Estimating Equations model. RESULTS: A total of 1,397 SLNs from 908 patients were confirmed to be metastatic. Seventy-one patients (1.7%) had confirmed pathologic N2 or N3 stage. Among metastatic SLNs, micrometastasis was found in 234 (16.8%). The overall accuracy of SLNB was 98.5%. The sensitivity and false-negative rate of FSE were 86.4% and 13.6%, respectively. Several clinicopathological factors, including the size of SLN metastases, suspicious preoperative axillary lymph nodes, and luminal B subtype, were associated with a higher rate of false-negative results. CONCLUSION: Most patients were not indicated for axillary lymph node dissection. Some patients may show transition in their permanent pathology due to the size of the metastatic node. However, the false-negative results of FSE for SLNs based on the size of the metastatic node did not change our practice. Therefore, intraoperative FSE for SLN should not be routinely performed for all breast cancer patients.

Evaluation of the accuracy of frozen section in different anatomical sites / Avaliação da acurácia diagnóstica do exame intraoperatório por congelação em diferentes sítios anatômicos

ABSTRACT INTRODUCTION: Frozen section is recommended in several situations to: establish the nature of a lesion; establish the presence of a lesion; confirm the presence of a benign lesion; confirm that sufficient tissue is present for diagnosis; establish the grade of the lesion; determine the organ of origin and determine the adequacy of margins. OBJECTIVES: To evaluate the accuracy of frozen section biopsy in multiple organs and analyze possible factors in discrepancy. METHODS: A retrospective study was carried out during a five-year period at a teaching hospital of Recife, Pernambuco, Brazil. The diagnoses of frozen section were compared with results obtained in the permanent section and classified as concordant or discordant. The discordant cases were reviewed by a pathologist and subdivided into false positives and false negatives. Possible reasons for discrepancy were indicated. RESULTS: A total of 1.226 specimens were analyzed, of which 1.181 (96.33%) were concordant and 45 (3.67%) were discordant. After the review of the discordant cases, 39 remained, six (15.4%) were false positives and 33 (84.6%) were false negatives. The tissue that had most false-positive results was mammary sentinel lymph node (3/1.2%), whereas ovarian showed most false negative outcomes with 17 specimens (51.51% of all false negatives). The possible reasons for discrepancy were sampling error, misunderstanding and complexity of the diagnosis. CONCLUSION: The frozen section accuracy of 96.3% found in our study is similar to specialized literature and does not seem to depend on the tissue analyzed.

RESUMO INTRODUÇÃO: O exame intraoperatório por congelação (EIC) visa avaliar histológica e intraoperatoriamente um pequeno fragmento de tecido ou órgão lesado no qual haja dúvida diagnóstica. Entre as indicações do EIC estão a determinação da natureza e a extensão da lesão, com consequente diferenciação entre lesões benignas e malignas, além da análise das margens cirúrgicas. OBJETIVOS: Avaliar a acurácia do EIC em múltiplos órgãos e analisar possíveis fatores de interferência. MÉTODOS: Foi realizado um estudo retrospectivo em um período de cinco anos (entre janeiro de 2011 e março de 2016) em um hospital de ensino da cidade do Recife, Pernambuco, Brasil. Os resultados dos EICs foram comparados com os laudos finais após o processamento histopatológico e classificados como concordantes ou discordantes. Os casos discordantes foram revistos por patologista e subdivididos em falso-positivos e falso-negativos. Possíveis causas para a discordância dos exames foram levantadas. RESULTADOS: Foram analisadas 1.226 peças cirúrgicas, das quais 1.181 (96, 33%) foram concordantes e 45 (3, 67%), discordantes. Após reavaliação dos casos discordantes, 39 permaneceram, sendo seis (15, 4%) falso-positivos e 33 (84, 6%) falso-negativos. A estrutura que mais apresentou resultado falso-positivo foi o linfonodo sentinela mamário (3/1, 2%), enquanto o ovário foi o órgão com mais resultados falso-negativos, com 17 amostras, 51, 51% de todos os casos negativos. As possíveis causas para a discordância foram tamanho da amostra, limitação do método e complexidade do diagnóstico. CONCLUSÃO: A acurácia do EIC encontrada neste estudo foi de 96, 3% e é semelhante à literatura especializada.

Comparison of cythopathology and frozen section methods in the intraoperative evaluation of breast sentinel lymph node / Comparação dos métodos de citopatologia e de cortes por congelação na avaliação intraoperatória do linfonodo sentinela de mama

ABSTRACT Introduction: Cytopathologic analysis (CP) and frozen section (FS) are available techniques for intraoperative evaluation of sentinel lymph node in surgeries for breast cancer treatment that will define the need for axillary lymphadenectomy. Objective: To compare CP and FS of axillary sentinel lymph nodes in metastasis detection of patients with breast cancer. Materials and methods: The electronic files from January 2010 and December 2014, from the Centro de Patologia de Curitiba, Parana, Brazil were reviewed, and were included all the cases in which the result of intraoperative exams by both methods, CP and FS, were recorded. The results of intraoperative exams were compared to the histopathology by hematoxylin and eosin (HE) staining. Results: A total of 183 sentinel lymph nodes from 94 patients were included. The mean age was 55 years and mean lymph node size was 11.70 mm. There was one false-positive case in both intraoperative methods and four false-negatives in FS, which were micrometastasis. FS's sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) and accuracy were respectively 80%, 99.38%, 94.11%, 96.42% and 97.26%. Regarding CP, there were six false-negative in which four were micrometastasis. CP's sensibility, specificity, PPV and NPV and accuracy were respectively 70%, 99.38%, 93.33%, 96.42% and 97.26%. Conclusion: The results of the present study shows that both CP and FS are reliable techniques for metastasis detection in breast sentinel lymph nodes, and are equivalent in sensibility, specificity, accuracy, PPV and NPV.

RESUMO Introdução: A análise citopatológica (CP) e o método de corte por congelação (CC) são técnicas disponíveis de avaliação intraoperatória do linfonodo sentinela nas cirurgias para tratamento de câncer de mama que vão definir a necessidade de linfadenectomia axilar. Objetivo: Comparar a avaliação CP e os CCs de linfonodos sentinela axilares na pesquisa de metástases em pacientes com câncer mamário. Materiais e método: Foram revisados os arquivos eletrônicos do Centro de Patologia de Curitiba, Paraná, Brasil, de janeiro de 2010 a dezembro de 2014, sendo incluídos os casos em que constavam o resultado do exame intraoperatório por ambos os métodos, CP e CC. Os resultados dos exames intraoperatórios foram comparados com a histopatologia, corada por hematoxilina e eosina (HE). Resultados: Foram incluídos 183 linfonodos sentinelas de 94 pacientes. A idade média foi de 55 anos, e o tamanho médio dos linfonodos, de 11,70 mm. Houve um caso falso positivo nos dois métodos intraoperatórios e quatro falso negativos na CC, entre os quais todos eram micrometástases. Sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia do CC foram, respectivamente, 80%, 99,38%, 94,11%, 96,42% e 97,26%. Já na CP, houve seis falso negativos, entre esses, quatro eram micrometástases. Sensibilidade, especificidade, VPP, VPN e acurácia da CP foram, respectivamente, 70%, 99,38%, 93,33%, 96,42% e 97,26%. Conclusão: Os resultados do presente estudo demonstraram que CP e CC são técnicas confiáveis para detecção de metástase em linfonodos sentinela de mama e se equivalem em sensibilidade, especificidade, acurácia, VPP e VPN.

Relationship between central lymph node metastasis and clinical features of papillary thyroid microcarcinoma / 肿瘤研究与临床

Objective To analyze the relationship between central lymph node metastasis and clinical features of papillary thyroid microcarcinoma. Methods From January 2010 to October 2016, 137 patients were treated with papillary thyroid microcarcinoma and central lymph node dissection. Among them, 35 were male and 102 were female. There were 49 cases with age ≤ 45 years old, 88 cases > 45 years old. 36 cases had diameter of tumor≤5 mm, 101 cases>5 mm; There were 72 cases with tumor fibrosis, 65 cases without fibrosis; 22 cases with psammoma bodies, 115 cases without psammoma bodies. There were 16 cases with tumor associated with chronic lymphocytic thyroiditis, 121 cases without them. The clinical factors affecting lymph node metastasis in the central group were analyzed byχ2 test. Results Of the 137 patients, 52 cases (38.0%) had central lymph node metastasis. Age, tumor diameter, fibrosis, psammoma bodies had relationship with central lymph node metastasis (χ2 values were 4.48, 5.60, 7.30, 7.30, all P 0.05). Conclusion The papillary thyroid microcarcinoma patients with age≤45 years old, tumor diameter>5 mm, fibrosis in the tumor area and psammoma bodies have high risk of lymph node metastasis.

The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery / 한국유방암학회지

PURPOSE: Intraoperative frozen-section analysis of the lumpect-omy margin during breast-conserving surgery (BCS) is an excellent method in obtaining a clear resection margin. This study aimed to investigate the usefulness of intraoperative circumferential frozen-section analysis (IOCFS) of lumpectomy margin during BCS for breast cancer, and to find factors that increase the conversion into mastectomy. METHODS: From 2007 to 2011, 509 patients with breast cancer underwent IOCFS during BCS. The outer surfaces of the shaved lumpectomy margins were evaluated. A negative margin was defined as no ink on the tumor. All margins were evaluated using the permanent section analysis. RESULTS: Among the 509 patients, 437 (85.9%) underwent BCS and 72 (14.1%) finally underwent mastectomy. Of the 483 pathologically confirmed patients, 338 (70.0%) were true-negative, 24 (5.0%) false-negative, 120 (24.8%) true-positive, and 1 (0.2%) false-positive. Twenty-four patients (4.7%) among total 509 patients had undetermined margins as either atypical ductal hyperplasia or ductal carcinoma in situ in the first IOCFS. The IOCFS has an accuracy of 94.8% with 83% sensitivity, 99.7% specificity, 93.4% negative predictive value, and 99.2% positive predictive value. Sixty-three cases (12.4%) were converted to mastectomy, the first intraoperatively. Of the 446 (87.6%) patients who successfully underwent BCS, 64 patients received additional excisions and 32 were reoperated to achieve clear margin (reoperation rate, 6.3%). Twenty-three of the reoperated patients underwent re-excisions using the second intraoperative frozen section analysis, and achieved BCS. Nine cases were additionally converted to mastectomy. No significant differences in age, stage, and biological factors were found between the BCS and mastectomy cases. Factors such as invasive lobular carcinoma, multiple tumors, large tumor, and multiple excisions increased the conversion to mastectomy. CONCLUSION: The IOCFS analysis during BCS is useful in evaluating lumpectomy margins and preventing reoperation.

Predictive Factors for Occult Contralateral Papillary Thyroid Carcinoma in Patients with Ipsilateral Multifocality on Frozen Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary thyroid carcinoma (PTC) frequently occurs as multifocal and bilateral tumors. However, multifocality and bilaterality are not easy to detect preoperatively and contralateral remnant tumor might lead to reoperation after hemithyroidectomy. We aimed to demonstrate the frequency of bilaterality and predictive factors for occult contralateral PTC when a frozen biopsy of hemithyroidectomy shows multifocal PTCs in one of the lobes. SUBJECTS AND METHOD: One hundred and thirty patients with PTC were enrolled in this study. All patients underwent hemithyroidectomy and frozen biopsy, followed by total thyroidectomy because of ipsilateral multifocality. Medical records, pathologic results, and preoperative ultrasound results were reviewed retrospectively. Patients were divided into two groups depending on bilaterality (unilateral or bilateral). RESULTS: Bilaterality was detected in 74 of 130 patients (56.9%). Bilateral group showed more number of carcinomas (3.9±1.4 vs. 2.3±0.9) and more tendency of existence of contralateral nodule (87.8% vs. 55.3%). Tumor size of 1 cm or more and contralateral nodules were significant predictive factors for the existence of occult contralateral PTC. The suspicious sonographic feature of contralateral nodule had 75.7% sensitivity and 75% specificity for detecting bilaterality. CONCLUSION: The incidence of bilateral PTC is high in patients with ipsilateral multiple tumors. When the frozen biopsy result shows multifocality in one of the lobes, the remnant tumor may lead to reoperation under recent guidelines on thyroid surgical extent. Characteristics of contralateral nodule can help physicians and patients to make the decision regarding surgical extent.

The Practice Patterns and Perceptions of Korean Surgeons Regarding Margin Status after Breast-Conserving Surgery / 한국유방암학회지

Two consecutive surveys for breast surgeons in Korea were conducted to comprehend the practice patterns and perceptions on margin status after breast-conserving surgery. The surveys were conducted online in 2014 (initial) and 2016 (follow-up). A total of 126 and 88 responses were obtained in the initial and follow-up survey, respectively. More than 80% of the respondents replied to routinely apply frozen section biopsy for intraoperative margin assessment in both surveys. Re-excision recommendations of the margin for invasive cancer significantly changed from a close margin to a positive margin over time (p=0.033). Most of the respondents (73.8%) defined a negative margin as “no ink on tumor” in invasive cancer, whereas more diverse responses were observed in ductal carcinoma in situ cases. The influence of guideline establishment for negative margins has been identified. A high uptake rate of intraoperative frozen section biopsy was noted and routine use needs reconsideration.

Comparación entre la citología por aspiración con aguja fina y la biopsia por congelación en el diagnóstico de las neoplasias malignas de la glándula tiroides:: un estudio prospectivo / Comparison between fine needle aspiration cytology and frozen section biopsy in the diagnosis of malignant neoplasms of the thyroid gland: a prospective study

Introducción. La citología obtenida mediante aspiración con aguja fina (cACAF) y la biopsia por congelación, se consideran actualmente pilares en el diagnóstico de las enfermedades nodulares de la glándula tiroides. El objetivo del presente estudio fue comparar su rendimiento en el diagnóstico de las neoplasias malignas de la glándula tiroides en la E.S.E. Hospital Universitario del Caribe. Materiales y métodos. En forma prospectiva, entre abril de 2014 y junio de 2015, se compararon los resultados de cada una de las citologías y biopsias obtenidas por un radiólogo y un cirujano de cuello con los del estudio anatomo-patológico. Se calcularon la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, la precisión diagnóstica, y la frecuencia de falsos positivos y falsos negativos. Se utilizó el índice kappa de concordancia para comparar el rendimiento de las citologías y las biopsias. Resultados. La población de estudio estuvo conformada por 85 pacientes, 92,9 % mujeres, con una edad promedio de 45,3 ± 14,7 años. Los resultados obtenidos para la citología obtenida mediante aspiración con aguja fina y la biopsia por congelación, respectivamente, fueron: sensibilidad, 80,0 % y 90,0 %; especificidad, 98,7 % y 100,0 %; valor predictivo positivo, 88,9 % y 100,0 %; valor predictivo negativo, 97,4 % y 98,7 %; precisión diagnóstica, 96,5 % y 98,8 %; porcentaje de falsos positivos, 1,2 % y 0,0 %, y porcentaje de falsos negativos, 2,4 % y 1,2 %; el índice kappa de concordancia fue de 0,952. Conclusiones. La cACAF y la biopsia por congelación mostraron un índice de concordancia de 0,952 en el diagnóstico de las neoplasias malignas de la glándula tiroides. Dichos resultados no sugieren el uso rutinario de la biopsia por congelación; sin embargo, sí sugieren su implementación en el manejo intraoperatorio de los pacientes con diagnósticos citológicos "sospechosos de malignidad", para disminuir la frecuencia de falsos positivos.

Introduction: Fine-needle aspiration cytology (FNAC) and frozen section (FS) are currently considered cornerstones in the diagnosis of thyroid gland nodular lesions. The main goal of the present study is to prospectively compare the performance of FNAC and FS in the diagnosis of malignant neoplasms of the thyroid at the E.S.E Hospital Universitario del Caribe, Cartagena, Colombia. Methods: Between April 2014 and June 2015, FNAC and FS were obtained in a prospective way by a radiologist and a neck surgeon, respectively. The results of the FNAC and the FS were compared with the pathology report. The following performance parameters were included: sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, false positive and false negative percentage. The kappa index for concordance was used to compare the performance of FNAC and FS. Results: The population study consisted of 85 patients, 92,9% female, with average age 45,3 ± 14,7 years. The following performance parameters for FNAC and FS were determined: sensitivity 80,0% / 90,0%; specificity, 98,7% / 100,0%; positive predictive value 88,9% / 100,0%; negative predictive value, 97,4% / 98,7%; diagnostic accuracy 96,5% / 98,8%; false positives percentage, 1,2% / 0.0%, false negatives percentage, 2,4% / 1,2% and kappa index for concordance of 0.952. Conclusion: FNAC and the FS have a concordance index of 0.952 in the diagnosis of thyroid malignant neoplasms. These results do not suggest the routine use of FS, however they do suggest that the use of FS in the intraoperative management of patients with cytologic diagnosis of "suspicious for malignancy" lower even more the frequency of false positives.

The application of optical coherence tomography to measure the thickness of rabbit knee joint cartilage / 实用放射学杂志

Objective To study the feasibility of the measurement of the thickness of rabbit knee joint cartilage by comparing the optical coherence tomography (OCT)and the undecalcified frozen section method on respectively measure the thickness of New Zeal-and white rabbit’s knee cartilage.Methods 50 standardized cultivation,adult and male New Zealand white rabbits (100 knees) were selected in this study.The measurement point was at the knee weight-bearing area of the medial femoral condyle with a 2 milli-meter diameter trephine,and the cartilage thickness data at the same center point and ±0.5 mm from the center were obtained.OCT and freeze-sectioning method were adopted at each site,respectively.The difference between OCT and histological method was com-pared and Bland-Altman plot was constructed.Results The thickness results of the center,+0.5 mm,-0.5 mm points were (296.5± 1.6)μm,(302.6± 3.5)μm,(287.9±5.6)μm by OCT,(278.4±1.9)μm,(290.3±5.9)μm,(280.3±4.6)μm by freeze-sectio-ning method,respectively.In Bland-Altman diagram,mean difference and 95% confidence interval were 18.1 1 (1 6.65,1 9.56)μm, 12.4 (5.5,1 9.2)μm,7.4 (2.8,12.0)μm.Intra-class correlation coefficients(ICC)for resemblance between the 2 techniques were 0.93(95%CI:0.89-0.95,P <0.000 1),0.84(95%CI:0.77-0.89,P <0.000 1),0.91(95%CI:0.87 -0.94,P <0.000 1),respec-tively.Conclusion As compared with the measurement of undecalcified frozen section,OCT for the rabbits’knee joint cartilage thickness measurement is feasible with the advantages of noninvasiveness,good repeatability.OCT can provide data reference in ani-mal experiments of cartilage tissue engineering for articular cartilage defect repair.

Hyalinizing trabecular tumor of the thyroid: diagnosis of a rare tumor using ultrasonography, cytology, and intraoperative frozen sections

PURPOSE: The goal of this study was to evaluate the clinicopathological and imaging features of thyroid nodules surgically diagnosed as hyaline trabecular tumor (HTT), and to assess the role of cytology and frozen sections (FS) in the diagnosis of HTT. METHODS: This study included 21 thyroid nodules in 21 patients treated from August 2005 to March 2015 (mean age, 53.3 years) who were either diagnosed as HTT or had HTT suggested as a possible diagnosis based on cytology, FS, or the final pathology report. Patients' medical records were retrospectively reviewed for cytopathologic results and outcomes during the course of follow-up. Sonograms were reviewed and categorized. RESULTS: Twelve nodules from 12 patients were surgically confirmed as HTT. Ultrasonography (US)-guided fine needle aspiration (FNA) was performed on 11 nodules, of which six (54.5%) were papillary thyroid carcinoma (PTC) or suspicious for PTC and three (27.3%) were HTT or suspicious for HTT. Intraoperative FS suggested the possibility of HTT in seven nodules, of which four (57.1%) were confirmed as HTT. US-FNA suggested the diagnosis of HTT in 10 nodules, of which three (30.0%) were confirmed as HTT. Common US features of the 12 pathologically confirmed cases of HTT were hypoechogenicity or marked hypoechogenicity (83.4%), absence of calcifications (91.7%), parallel shape (100.0%), presence of vascularity (75.0%), and probable benignity (58.3%). CONCLUSION: HTT should be included in the differential diagnosis of solid tumors with hypoechogenicity or marked hypoechogenicity and otherwise benign US features that have been diagnosed as PTC through cytology.

Accuracy of intraoperative consultation in thyroid nodules: analysis of 2,040 cases performed at Instituto Nacional de Câncer in 12 years / Acurácia da consulta intraoperatória nos nódulos da tireoide: análise de 2.040 casos realizados no Instituto Nacional de Câncer em 12 anos

ABSTRACTIntroduction:The thyroid nodule is the most common clinical manifestation of thyroid diseases, and, among the procedures for its diagnosis, cytological examination is the most used. Due to the high accuracy of cytological examination, the value of intraoperative consultation (IOC) has become a matter of controversy. IOC is one of the most important and difficult procedures that a pathologist adopts, enabling the patient to be diagnosed, treated and staged in the same intervention.Objective:To evaluate the accuracy of IOC in thyroid at Instituto Nacional de Câncer (Inca).Methods:This study analyzed IOC in thyroid held in Inca from January 2001 to December 2012. The IOC diagnosis was compared with the histopathologic diagnosis, considered the gold standard, and was classified as concordant, discordant and indeterminate. From these data we calculated sensitivity, specificity and accuracy.Results:Among the 2,040 held IOCs, diagnoses were concordant in 1,770 cases (87%), discordant in 45 (2%) and indeterminate in 225 (11%). Among the 1,770 concordant cases, 1,252 (61%) were true negative, and 518 (25%), true positive. Among the 45 discordant cases, 38 (2%) were false negative, and seven (0,3%), false positive. The test sensitivity was 0.94%, specificity of 0.99% and accuracy of 0.97%.Conclusion:Our results indicate that IOC in thyroid is a highly accurate test, contributing to the surgical conduct.

RESUMOIntrodução:O nódulo tireoidiano é a manifestação clínica mais comum de doenças da tireoide, e entre os procedimentos para o seu diagnóstico, o exame citológico é o mais usado devido à alta acurácia. Como consequência, o valor da consulta intraoperatória (CIO) tornou-se motivo de controvérsia. A CIO é um dos mais importantes e difíceis procedimentos que o patologista utiliza. Ela possibilita que o paciente seja diagnosticado, tratado e estadiado em uma mesma intervenção.Objetivo:O objetivo deste trabalho é avaliar a acurácia da CIO em tireoide no Instituto Nacional de Câncer (Inca).Métodos:Este estudo analisou as CIOs em tireoide realizadas no Inca no período de janeiro de 2001 a dezembro de 2012. O diagnóstico delas foi comparado com o diagnóstico histopatológico, considerado o padrão ouro, e foi classificado em: concordante, discordante e indeterminado. A partir desses dados, foram calculadas a sensibilidade, a especificidade e a acurácia.Resultados e conclusão:Das 2.040 CIOs realizadas, os diagnósticos foram concordantes em 1.770 casos (87%), discordantes em 45 (2%) e indeterminados em 225 (11%). Dos 1.770 casos concordantes, 1.252 (61%) foram verdadeiros negativos e 518 (25%), verdadeiros positivos. Dos 45 casos discordantes, 38 (2%) foram falsos negativos e sete, falsos positivos (0,3%). A sensibilidade do exame foi de 0,94%; a especificidade, de 0,99%; e a acurácia, de 0,97%. Nossos resultados indicam que a CIO em tireoide é um exame de alta acurácia, o que contribui para a conduta cirúrgica.

Surgical Pathology and Intraoperative Consultation: An Audit

Background: While intraoperative consultation has been used in Bangladesh for a long period of time, to date, there has been no published reporting on the performance of frozen sections. The current audit evaluates the performance of frozen sections in a well reputed medical center in Bangladesh, Anowara Medical Services. Objective: This retrospective study has been designed to measure the accuracy of frozen section diagnosis in a medical center in a third-world country, where many surgical procedures rely on intraoperative consultation. Methods: A series of 1379 intra- and peri-operative frozen section cases, from 2007 to 2014, was reviewed. Intraoperative tissue specimens received at Anowara Medical Services were processed for frozen sections. After examination of the frozen section that yielded the initial frozen section diagnoses, the frozen tissues were reprocessed for regular paraffin sectioning. These paraffin sections were examined by a second pathologist, and a final diagnosis was issued. The frozen section diagnosis and final diagnoses of all cases were retrospectively analysed to determine the accuracy of frozen section examination. Results: Overall, accurate diagnosis was made on frozen sections in 98.2% of the cases. The discrepant diagnoses were all clinically significant, i.e., there were discrepancies between benign and malignant diagnoses on frozen and paraffin sections. In 1% of the cases, diagnosis was deferred. Fifty percent of the deferred cases were benign. Two cases, received in formalin, were excluded. In both cases, the diagnosis was positive for malignancy. The number of false negative results (4 false negatives) was slightly lower than that of false positives (5 false positives). Specificity and sensitivity of 99.3% and 99.4% were achieved, respectively. In this study, the positive predictive value was 99.2% and the negative predictive value was 99.5%. Over the years, the number of discrepant diagnoses remained fairly constant. Conclusion: The present method has a satisfactory rate of accuracy of frozen section diagnosis, which is comparable to other remote and recent published series. The results of this study offer a testament to the reliability of frozen section diagnosis rendered by qualified pathologists in Bangladesh and may serve as evidence in building confidence among the surgeons who use this service for improved patient care.

Preliminary differential proteome analysis of the human primary or lymph node metastatic gastric adenocarcinoma by two-dimensional differential gel electrophorosis / 肿瘤研究与临床

Objective To establish differential protein expressing profiles of human gastric adenocarcinoma cell in primary or metastatic lymph node tissues by two-dimensional differential gel electrophorosis (2-D DIGE) so as to investigate the metastatic molecular mechanism of the gastric cancer.Methods After obtaining 6 samples of human primary gastric cancer and metastatic lymph node tissues,with manual no-staining frozen sections microdissection,human gastric adenocarcinoma cells from primary or metastatic lymph node tissues were isolated,and then the total proteins were extracted and purified.Highly sensitive 2-D DIGE was used to separate the total protein differentially expressed in the cells.The proteins were visualized by using a fluorescence scanner at appropriate wavelengths for Cy2,Cy3 and Cy5 dyes (Typhoon 9400).Image analysis was carried out with the DeCyder-Differential analysis software (Biological Variation Analysis version 5.0).Results Not only can the study procure defined adenocarcinoma cell populations from gastric primary or metastatic lymph node tissues,but also can resolve the problem of the change in 2-D DIGE patterns because of the varying in protein changes owing to dyeing.All these showed that the technique was simple,easy to perform,versatile and of particular usefulness when laser capture microdissection (LCM) was practically unavailable.The 2-D DIGE patterns with high resolution and reproducibility from adenocarcinoma cells in gastric primary or metastatic lymph node tissues were obtained.The number of spots in Gel1,Gel2 were 1 416 (similar 1 062,decrease 277,increase 77),1 299 (similar 1 050,decrease 157,increase 92),respectively.A total of 11 differential proteins were acquired by image analysis with DeCyder-Differential analysis software (Biological Variation Analysis version 5.0).Conclusions In this report,a simple,easy to proform method of protein epuration,manual no-staining frozen sections microdissection is described,and have used the highly sensitive 2-D DIGE for the identification of proteins differentially expressing in human gastric adenocarcinoma cells from primary or metastatic lymph node tissues.These results provide a fundamental basis for further study of metastatic mechanism of gastric cancer and screen its specific markers.

Calretinin immunohistochemistry versus improvised rapid Acetylcholinesterase histochemistry in the evaluation of colorectal biopsies for Hirschsprung disease.

Background: Acetylcholinesterase (AChE) histochemistry on rectal mucosal biopsies accurately diagnoses Hirschsprung disease (HD), but is not widely employed as it requires special tissue handling and pathologist expertise. Calretinin immunohistochemistry (IHC) has been reported to be comparable to AChE staining with the loss of expression correlating with aganglionosis. Aim: The aim was to evaluate calretinin IHC as a primary diagnostic tool in comparison to the improvised rapid AChE technique in the diagnosis of HD. Materials and Methods: A total of 74 rectal biopsies (18 fresh frozen - 18 cases, 56 formalin fixed - 33 cases) from 51 cases of suspect HD were evaluated with hematoxylin and eosin/AChE/Calretinin. Ten biopsies each from ganglionated and aganglionated segments served as positive and negative controls. Ileal (3), appendiceal (3) and ring bowel (2) biopsies were also included. Two pathologists blinded to the clinical details evaluated the histomorphology with AChE and calretinin. Observations were statistically analyzed and Cohen’s κ coefficient employed to assess agreement between two pathologists and calretinin and the AChE. Results: The study confirmed HD in 26 and non-HD in 25 cases. There were 7 neonates, 5 low level biopsies and 14 “inadequate” biopsies. The results of calretinin were comparable with AChE with a statistically significant measure of agreement of κ = 0.973 between the two. One false-positive case of HD was noted with calretinin. The advantages and disadvantages of calretinin versus AChE are discussed. Conclusion: Calretinin is a reliable single immune marker for ruling out HD by its specific positive mucosal staining of formalin fixed rectal biopsy. The improvised AChE staining remains indispensable to confirm HD on fresh biopsies and thus, along with calretinin IHC maximizes the diagnostic accuracy of HD in difficult cases.

Percutaneous core biopsy of palpable breast lesions: accuracy of frozen section histopathological exam in the diagnosis of breast cancer / Avaliação da acurácia do exame histopatológico por congelação em fragmentos de tecido obtidos por biópsia percutânea com agulha grossa no diagnóstico do câncer de mama em tumores palpáveis

OBJECTIVE: to evaluate the accuracy of frozen section histopathology from fragments of tissue obtained by percutaneous core needle biopsy of palpable tumors in the diagnosis of breast cancer. METHODS: a cohort study was performed on 57 patients with palpable tumors and suspected breast cancer undergoing percutaneous thick needle core biopsy. The fragments were analyzed by the same pathologist. RESULTS: frozen section diagnosed 16 benign cases (28.6%) and 40 malignant (71.4%), whereas paraffin showed that 15 were benign (26.8%) and 41 malignant (73.2%). Histopathological examinations were concordant in 55 cases and there was one false-negative (6.2%). Statistics rates were: negative predictive value of 93.8%, positive predictive value of 100%, no false-positive (0%), one false negative (6.2%), specificity of 100%, sensitivity of 97 6%; observed agreement = 98.2%; expected agreement = 59.9%, Kappa = 0.955 [ 95% CI = 0.925-0.974, p < 0.01 ]. CONCLUSIONS: frozen section histopathological findings showed excellent correlation with the findings by the technique in paraffin in the fragments of palpable breast tumors obtained by thick needle percutaneous core biopsy (98.2% accuracy). Therefore, in these patients, it was possible to anticipate the diagnosis, staging and the breast cancer treatment planning. .

OBJETIVO: avaliar a acurácia do exame histopatológico por congelação em fragmentos de tecido obtidos por biópsia percutânea com agulha grossa no diagnóstico do câncer de mama em tumores palpáveis. MÉTODOS: foi realizado estudo de coorte em 57 pacientes portadoras de tumores palpáveis e suspeitos de câncer de mama, submetidas à biópsia por punção percutânea com agulha grossa. Os fragmentos foram analisados pela mesma anatomopatologista. RESULTADOS: a congelação diagnosticou 16 casos benignos (28,6%) e 40 malignos (71,4%), enquanto a parafina revelou que 15 eram benignos (26,8%) e 41 malignos (73,2%). Os exames histopatológicos foram concordantes em 55 casos e houve um falso-negativo (6,2%). As taxas estatísticas foram: valor preditivo negativo de 93,8%, valor preditivo positivo de 100%, nenhum falso-positivo (0%), um falso-negativo (6,2%), especificidade de 100%; sensibilidade de 97,6%; concordância observada = 98,2%; concordância esperada = 59,9%; Kappa = 0,955 [IC 95% = 0,925 a 0,974, p<0,01]. CONCLUSÃO: Os achados histopatológicos por congelação apresentaram excelente correlação com os achados pela técnica em parafina nos fragmentos de tumores mamários palpáveis obtidos por punção percutânea com agulha grossa (acurácia de 98,2%). Logo, nestas pacientes, foi possível antecipar o diagnóstico, o estadiamento e a programação terapêutica do câncer de mama. .