Examining the accuracy and clinical usefulness of intraoperative frozen section analysis in the management of pancreatic lesions

Nelson, Daniel W.; Blanchard, Terin H.; Causey, Marlin Wayne; Homann, Joseph F.; Brown, Tommy A.

doi:10.1016/j.amjsurg.2013.01.015

Cited by 40 publications

(35 citation statements)

References 17 publications

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“…The accuracy of frozen section and histological interpretation has increased from 65 to 75% in 1980s to above 90% in recent studies [75,76,79]. The sensitivity was found between 70.7 and 89.7% across various studies, whereas positive predictive value was found to be nearly 100% [79][80][81].…”

Section: Intraoperative Evaluationmentioning

confidence: 99%

“…The sensitivity was found between 70.7 and 89.7% across various studies, whereas positive predictive value was found to be nearly 100% [79][80][81]. However, the major concern with frozen analysis is the relatively low negative predictive value (50%) [79]. The false negativity of frozen examination was 1.2-30%, and this rate increases in the presence of background CP because of the presence of reactive duct changes or atrophy [82].…”

Section: Intraoperative Evaluationmentioning

confidence: 99%

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Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Narkhede

Desai

Prasad

et al. 2019

Dig Dis

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Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP) is as high as 5%. It is a commonly encountered diagnostic challenge in patients with CP on long-term follow-up. Summary: This review consolidates the existing literature on assessment of PDAC in background of CP, its evaluation through the available investigations, surgical management, and prognostication. Recent change in symptomatology of an otherwise stable CP should raise a suspicion of malignancy. Endoscopic ultrasound (EUS) is more specific and sensitive in establishing the diagnosis of PDAC compared to cross-sectional imaging (computed tomography/magnetic resonance imaging). Intraoperative assessment with careful palpation coupled with careful clinical judgment helps in differentiating between an inflammatory mass and pancreatic cancer. Confirmation can be obtained with either preoperative EUS-guided fine needle cytology/core biopsy or intraoperative core biopsy under ultrasound guidance. However, despite complete evaluation with above options, 1–6% patients often show malignancy on final histopathological examination. Key Messages: Diagnosis of PDAC in CP needs a high index of suspicion. Cross-sectional imaging has poor negative predictive value. CA 19-9 with MUC5AC combination may become an ideal investigation. EUS with core biopsy/frozen section has a good sensitivity and specificity and low false negative results. Complete radical resection should be the aim to get long-term survival.

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Section: Intraoperative Evaluationmentioning

confidence: 99%

Section: Intraoperative Evaluationmentioning

confidence: 99%

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Narkhede

Desai

Prasad

et al. 2019

Dig Dis

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“…It is safe, fast and easy to perform; however, it requires significant processing and evaluating time [46]. Additional resection in case of positive resection margins seems logical, but several studies describe no significant survival benefit after reresection [47–49].…”

Section: Current Strategiesmentioning

confidence: 99%

“…The use of nonstandardized methods for histopathological analysis greatly influences the reporting of resection margin status [13, 17, 50]. This may explain the low sensitivity of only 33% in evaluating final resection margin status using IFSA [46]. Due to this inconsistent reporting, little is known on the relation between exact tumor location within the pancreas and margin involvement.…”

Section: Current Strategiesmentioning

confidence: 99%

Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery

Handgraaf

Boonstra

Erkel

et al. 2014

BioMed Research International

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Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery.

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“…One of the most challenging issues that continue to plague surgeons is obtaining negative margins during surgery. The current "gold standard" is frozen section analysis of submitted margins by the pathologist [1][2][3] . This technique is fraught with several technical and conceptual limitations, which have been recognized in the literature.…”

Section: Introductionmentioning

confidence: 99%

How Close Are We to Real Time Optical Margin Control in Head and Neck Oncologic Surgery?

Miles

2016

Cancer Cell Microenviron

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The quest for negative margins during head and neck oncologic surgery continues to challenge surgeons worldwide. Current technological advances offer significant promise to advance the field and improve operative margin detection. This review focuses on current optical technology, which has been evaluated for intraoperative margin control in head and neck oncologic surgery. Many of the current systems have technical limitations and there is no current standard technology being applied in the field of head and neck oncology to enhance intraoperative margin control. Surgeons continue to rely on intraoperative frozen section analysis, however many optical systems have shown high rates of sensitivity and specificity when discriminating benign from malignant tissue. These technologies shows significant promise for intraoperative margin control and may be enhanced by targeted molecular imaging, or spectral analysis, in the future. Translational trials are rare and are the key to the path of independence from frozen section analysis.

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Examining the accuracy and clinical usefulness of intraoperative frozen section analysis in the management of pancreatic lesions

Cited by 40 publications

References 17 publications

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery

How Close Are We to Real Time Optical Margin Control in Head and Neck Oncologic Surgery?

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