ABSTRACT
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.
ABSTRACT
PURPOSE: Gold standard treatment for invasive penile carcinoma remains amputation and lymphadenectomy. This procedure has high morbidity and new prognostic factors on the incidence of metastasis would help select candidates to lymphadenectomy. Mutations in the p53 gene common in several neoplasms can be related to the prognosis. We studied 82 patients with penile carcinoma staged according to the 1978 TNM system who underwent amputation and bilateral lymphadenectomy to evaluate the prognostic value of immunohistochemical p53 staining in the primary tumor. MATERIALS AND METHODS: Immunoreactivity of p53 was studied with other clinicopathological variables, including patient age, stage, histological grade, tumor thickness, lymphatic and venous embolization, corpora cavernosa, corpus spongiosum and urethral infiltration, and human papillomavirus (HPV) status. We also determined its association with lymph node metastasis, the survival rate and the risk of death. In addition, we studied the association of p53 and HPV DNA with prognosis. All slides were reviewed by 1 pathologist. HPV DNA was detected by polymerase chain reaction using GP5/6+ generic primers. p53 expression was measured by immunohistochemical testing with monoclonal Clone DO-7 mouse anti-human p53 protein antibody (Dako A/S, Glostrup, Denmark). The Cox regression hazards method was used for multifactorial analysis. RESULTS: Nuclear accumulation of p53 was detected in 34 of 82 samples (41.5%). Clinical lymph node N stage (p = 0.045), lymphatic (p <0.001) and venous (p = 0.04) embolization by neoplastic cells, p53 positivity (p = 0.012) and p53 grade (p = 0.004) were significantly associated with lymph node metastasis. Followup was 0.1 to 453 months (mean 88.7). Multivariate analysis revealed that only lymphatic embolization (relative risk 9.4, 95% confidence interval [CI] 2.8 to 31.6) and p53 positivity (relative risk 4.8, 95% CI 1.6 to 14.9) were independent factors for lymph node metastasis. Patients with negative p53 had significantly better 5 and 10-year overall survival than those in whom tumors stained positive for p53 (64.5% and 54.6% versus 30.2% and 26.4%, respectively, p = 0.009). When tumors were p53 positive and HPV DNA positive, overall survival was worse. Multivariate analysis revealed that only age (relative risk 2.9, 95% CI 1.6 to 5.1) and lymph node metastasis (relative risk 3.2, 95% CI 1.8 to 5.8) were independent risk factors for death. CONCLUSIONS: Immunoreactivity of p53 is an independent factor for lymph node metastasis. The association of positive p53 with positive HPV DNA was related to a worse prognosis.
