Tumor de ovario borderline: concordancia entre biopsia contemporánea y biopsia definitiva / Borderline tumor of the ovary: accuracy of intraoperative frozen section and definitive biopsy

OBJETIVO: Los tumores de ovario borderline (BOT) son un grupo de lesiones neoplásicas de origen epitelial del ovario que presentan características de tumores malignos, pero sin invasión del estroma, y se caracterizan por tener un buen pronóstico. El objetivo del estudio es determinar la concordancia diagnóstica entre biopsia contemporánea y definitiva de los BOT en nuestro centro hospitalario. MÉTODO: Se realizó un estudio analítico retrospectivo de corte transversal de las biopsias contemporáneas y definitivas de BOT en la base de datos de anatomía patológica del Hospital Padre Hurtado, entre los años 2010 y 2019. El análisis estadístico de concordancia se realizó mediante test de kappa. RESULTADOS: Se revisaron 4546 informes de biopsias entre los años 2010 y 2019. Se pesquisaron 163 tumores malignos de ovario, de los cuales 69 (42,33%) correspondieron a BOT. De estos, 39 fueron serosos (56,2%), 28 mucinosos (40,57%) y 2 (2,8%) de tipo endometrioide. El resultado de concordancia diagnóstica de BOT seroso es moderada, del 75,71% con un índice de kappa de 0,5143 (p = 0,000), y el de BOT mucinoso es débil, del 65,71% con un índice de kappa de 0,2398 (p = 0,0222). CONCLUSIONES: Los BOT corresponden a un gran porcentaje dentro de los tumores malignos del ovario, siendo el subtipo seroso el más común. La concordancia entre biopsia contemporánea y definitiva es de débil a moderada.

OBJECTIVE: Borderline ovarian tumors (BOT) are a group of neoplastic lesions of epithelial origin of the ovary that present characteristics of malignant tumors but without stromal invasion and are characterized by having a good prognosis. The objective of the study is to determine the concordance between frozen section and definitive biopsy of BOT in our hospital center. METHOD: A retrospective, cross-sectional analytical study of the frozen section and definitive BOT biopsies was performed in the pathological anatomy database of the Padre Hurtado Hospital during the years 2010 and 2019. The statistical and concordance analysis was performed using kappa tests. RESULTS: 4546 biopsy reports were reviewed during 2010 and 2018. A total of 163 malignant ovarian tumors were investigated, of which 69 (42%) corresponded to BOT. Of these, the most common subtypes were 39 (56.2%) serous, 28 (40.57%) mucinous and 2 (2.8%) endometroid. The concordance results of serous BOT is moderate, 75.71% with a kappa index of 0.5143 (p = 0.000), and mucinous BOT have fair concordance, 65.71% with a kappa index of 0.2398 (p = 0.0222). CONCLUSIONS: BOT correspond to a large percentage of malignant tumors of the ovary, with the serous subtype being the most common. The concordance between contemporary and definitive biopsy is between fair and moderate.

Retrospective Study on Accuracy of Intraoperative Frozen Section Biopsy in Spinal Tumors.

OBJECTIVE: Histologic types and grades are critical in the diagnosis and treatment of spinal tumors. Intraoperative frozen section is a fast and easy method in confirming pathologic diagnosis during the operation. This study was undertaken to reveal the accuracy of intraoperative frozen section biopsy in order to make proper treatment plans. METHODS: This retrospective study concerned patients who underwent spinal tumor surgeries from 1 January, 2012 to 31 December, 2016. Frozen section biopsy and permanent biopsy were compared, and cases that had differences were counted. RESULTS: Thirty-seven cases out of 324 patients had discrepancies (11.4%). In discrepant cases 11 cases were ependymoma (29.7%) and 6 cases were schwannoma (16.2%). Among 34 patients who were finally diagnosed with an ependymoma, 11 cases had discrepancies, which was the highest mismatch rate among tumor final pathologic types. By frozen biopsy, astrocytoma (n = 5) and ependymoma (n = 5) turned out to be the most discrepant pathologic types and 16 frozen section biopsy cases were "null." Frozen biopsy astrocytoma (n = 5) mostly turned out to be ependymoma in 4 cases. CONCLUSIONS: Pathologic findings from frozen biopsy for spinal cord tumors could not be corresponded to final diagnosis, especially when the results of frozen biopsy were ependymoma or astrocytoma. Therefore careful decision making for treatment plans is required.

Role of Frozen Biopsy in Glottic Premalignant Lesions.

Frozen biopsies are frequently used for decision making during surgery. This study aimed to evaluate the efficacy of frozen biopsy for guiding decision making before laser excision of glottic premalignant lesions. One hundred patients with 119 laser excisions were included in this study and reviewed retrospectively. After frozen biopsy, type I or II cordectomy was performed and the frozen result and final pathology of the excisional specimen were compared. The positive predictive value of frozen biopsy when the diagnosis is benign or malignant was relatively high (80.8 and 88.9 %, respectively) but the positive predictive value of a dysplasia or carcinoma in situ result was quite low (18.2 and 16.7 %). Under-diagnosis was frequent for dysplasia or carcinoma in situ (69.7 and 83.3 %). In particular, for lesions with suspicious features, lesions with dysplasia or carcinoma in situ had a much higher rate of under-diagnosis (81.8 and 100 %). Frozen biopsy was not reliable because the overall coincidence rate between final pathology and frozen biopsy was 63 %. Although a frozen biopsy result of a benign or malignant result was reliable, a dysplasia or carcinoma in situ result on frozen biopsy had a high risk of being an under-diagnosis.

Long-term outcomes of surgical treatment for dermatofibrosarcoma protuberans according to width of gross resection margin.

BACKGROUND: Controversy exists regarding appropriate surgical treatment for dermatofibrosarcoma protuberans (DFSP). The purpose of this study was to propose treatment recommendations based on long-term outcomes of surgical treatments for DFSP. METHODS: A total of 63 patients who underwent surgical resection for primary DFSP were retrospectively reviewed from 1999 to 2011. They were classified into three groups based on the width of the gross resection margins: group I with marginal excision (14 patients); group II with resection margins < 3 cm (21 patients); and group III with resection margins ≥ 3 cm (28 patients) (group II and group III had wide local excision). RESULTS: The median follow-up period was 65 months (range 31-190 months). The marginal excision group showed a significantly higher recurrence rate than the wide excision group (35.7% vs. 0%, p < 0.001). Among wide excision groups, group III showed a significantly higher requirement for reconstructive surgery than group II (82.7% vs. 52.4%, p = 0.011), yet both groups had no recurrence and pathologic margin status was comparable. The accuracy rate of frozen section analyses was 100% for the margin status in the wide excision group. Adjuvant radiation was significantly associated with a reduced recurrence in the marginal excision group (0% vs. 60%, p = 0.016). CONCLUSIONS: Wide local excision with margins of 1.5-2 cm along with frozen biopsy is recommended for DFSP. Either re-excision or adjuvant radiation therapy can serve as a treatment option for patients with positive margins.

Diagnóstico de las afecciones nodulares del tiroides / Diagnosis of the thyroid nodular disorders

A pesar de los avances en los medios de diagnóstico, la identificación de los nódulos malignos del tiroides continúa siendo un reto para los patólogos, endocrinólogos y cirujanos. Aunque los factores pronósticos, la aplicación del método clínico y los estudios imagenológicos y funcionales pueden contribuir al diagnóstico; sus pilares fundamentales lo constituyen el estudio citológico mediante punción aspirativa con aguja fina, la biopsia intraoperatoria por congelación y la biopsia por inclusión en parafina. Al respecto, en el presente trabajo se ofrecen algunas consideraciones relacionadas con el diagnóstico del nódulo tiroideo.

In spite of the advances in the diagnosis means, the identification of the malignant nodules of the thyroid continues being a challenge for the pathologists, endocrinologist and surgeons. Although the prognosis factors, the use of the clinical method and the imagenological and functional studies can contribute to the diagnosis; their main key stone is constituted by the cytological study through fine needle aspiration, the frozen intraoperative biopsy and the paraffin inclusion biopsy. In this respect, some considerations related to the diagnosis of the thyroid nodule are offered in this work.

Biopsia por congelación: recomendaciones en la práctica clínica y dermatológica / Frozen biopsy: Recommendations in clinical and dermatology practice

Los avances en histotecnología han permitido a lo largo de los años el desarrollo de diferentes técnicas diagnósticas en la práctica de la patología. Entre estas técnicas se encuentra la biopsia por congelación, sin embargo, en el ámbito clínico es común el desconocimiento de esta herramienta diagnóstica. Presentamos una breve revisión acerca de sus limitaciones, sus posibles indicaciones y los casos en los que la biopsia por congelación brinda información importante al clínico para orientar una modificación terapéutica. Al final se hace énfasis sobre las consideraciones a tener en cuenta sobre la biopsia por congelación de piel y las condiciones clínicas en las cuales resulta útil.

The advances in histotechnology over the years have enabled the development of different diagnostic techniques in the pathology practice. These techniques include frozen biopsy; however, in the clinical field use of this diagnostic tool generally unknown. A brief review of their limitations are presented, along with their possible indications, as well as cases in which frozen biopsy provides important information to the clinician to guide therapeutic changes. Finally, emphasis is placed on the considerations to take into account in frozen skin biopsy, and the clinical conditions in which it is useful. © 2013 Instituto Nacional de Cancerología. Published by Elsevier España, S.L.U. All rights reserved.

Caracterización clinicoquirúrgica y anatomopatológica de pacientes con cáncer de tiroides en el período 1995-2011 / Clinical surgical and pathological characterization of patients with thyroid cancer in the period 1995-2011

Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal de 84 pacientes con cáncer de tiroides, atendidos en el Servicio de Cirugía General del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 1995 hasta abril de 2011, con vistas a caracterizarles desde los puntos de vista clínico, quirúrgico y anatomopatológico. En la serie predominaron el grupo de 31-45 años, el sexo femenino, el carcinoma papilar como la variedad histológica más frecuente -- con nódulos únicos -- y la disfonía como principal complicación. Se corroboró la eficacia de la ecografía en la detección de lesiones nodulares, así como también existió una elevada correspondencia entre los resultados de la citología aspirativa con aguja fina y el diagnóstico histológico; asimismo, la biopsia por congelación constituyó un procedimiento útil en citologías negativas o dudosas.

An observational, descriptive, retrospective and longitudinal study was carried out in 84 patients with thyroid cancer, attended in the General Surgery Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, from January, 1995 to April, 2011, with the purpose of characterizing them from the clinical surgical and pathological points of view. Age group of 31-45 years, female sex, papillary carcinoma as the most frequent histological variety -- with single nodules -- and dysphonia as a major complication prevailed in the series. The effectiveness of the ultrasound was confirmed by detecting nodular lesions, and there was a high correspondence between the results of the fine needle aspiration biopsy and histological diagnosis; also, frozen biopsy was an useful procedure in negative or doubtful cytologies.

Surgical Aspects of Subacute Thyroiditis / 대한내분비외과학회지

PURPOSE: Subacute thyroiditis (SAT) is an uncommon, self-lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. METHODS: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. RESULTS: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. CONCLUSION: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign.