Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections

Chatelain, Denis; Shildknecht, H.; Brasseur, Edmond; Darrac, I.; Régimbeau, Jean-Marc

doi:10.1016/j.jviscsurg.2012.01.005

Cited by 9 publications

(4 citation statements)

References 22 publications

(31 reference statements)

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“…To obtain a tumor diagnosis during surgical resection, histology is traditionally performed on frozen sections, which requires a pathologist in or near the operating room. The precision and the degree of certainty of this examination can be lower than that of definitive histology [ 4 ], which is the main pitfall in the event of cancer-mimicking inflammatory and fibrotic lesions [ 5 , 6 ]. Definitive pathological examination has been enriched with the help of identification of specific markers.…”

Section: Introductionmentioning

confidence: 99%

Rapid Diagnosis of Lung Tumors, a Feasability Study Using Maldi-Tof Mass Spectrometry

Brioude

Trousse²,

Flaudrops

et al. 2016

PLoS ONE

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ObjectiveDespite recent advances in imaging and core or endoscopic biopsies, a percentage of patients have a major lung resection without diagnosis. We aimed to assess the feasibility of a rapid tissue preparation/analysis to discriminate cancerous from non-cancerous lung tissue.MethodsFresh sample preparations were analyzed with the Microflex LTTM MALDI-TOF analyzer. Each main reference spectra (MSP) was consecutively included in a database. After definitive pathological diagnosis, each MSP was labeled as either cancerous or non-cancerous (normal, inflammatory, infectious nodules). A strategy was constructed based on the number of concordant responses of a mass spectrometry scoring algorithm. A 3-step evaluation included an internal and blind validation of a preliminary database (n = 182 reference spectra from the 100 first patients), followed by validation on a whole cohort database (n = 300 reference spectra from 159 patients). Diagnostic performance indicators were calculated.Results127 cancerous and 173 non-cancerous samples (144 peripheral biopsies and 29 inflammatory or infectious lesions) were processed within 30 minutes after biopsy sampling. At the most discriminatory level, the samples were correctly classified with a sensitivity, specificity and global accuracy of 92.1%, 97.1% and 95%, respectively.ConclusionsThe feasibility of rapid MALDI-TOF analysis, coupled with a very simple lung preparation procedure, appears promising and should be tested in several surgical settings where rapid on-site evaluation of abnormal tissue is required. In the operating room, it appears promising in case of tumors with an uncertain preoperative diagnosis and should be tested as a complementary approach to frozen-biopsy analysis.

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Section: Introductionmentioning

confidence: 99%

Rapid Diagnosis of Lung Tumors, a Feasability Study Using Maldi-Tof Mass Spectrometry

Brioude

Trousse²,

Flaudrops

et al. 2016

PLoS ONE

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“…1 University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany Furthermore, the operation is often stalled for 30 to 60 minutes while awaiting histological results from fresh frozen section. 9,10 Until now it is not feasible to assess peritoneal spots and resection margins in vivo and in real-time intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Confocal Laser Microscopy Without Fluorescent Injection

et al. 2016

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Introduction Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumors plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex vivo study demonstrates a CLM camera device for minimal invasive surgical approach. Methods In 5 cases, a laparoscopic CLM camera was used for examining colon and rectum specimen. Images of nonmalignant and malignant intestinal mucosa were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Results Using this CLM camera device, it is possible to analyze colon specimen mucosa. Nonmalignant and malignant intestinal mucosa show specific signal patterns. Nonmalignant mucosa is defined by honeycomb structure. There is deregulated structure in colon and rectum carcinoma mucosa. The inside lumen is irregular. The radial border appears swollen with reduced contrast. Discussion This pilot study shows that the assessment of colon mucosa with a prototype of CLM camera for minimally invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant mucosa in colon specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.

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“…Because frozen section analysis is typically limited and involves no cell labeling or staining, it can yield false positives and false negatives. It has been associated to more than 7% discordant or doubtful results in some studies [3,5] and up to a 42% misclassifications rate in safety margin assessment in certain lung cancer studies [6]. In the absence of complementary methods for tissue analysis in the operating room, decisive action has to be taken before the definite diagnosis.…”

Section: Introductionmentioning

confidence: 99%

MALDI-ToF Mass Spectrometry for the Rapid Diagnosis of Cancerous Lung Nodules

Brioude¹,

Dominicis²,

Atieh

et al. 2014

PLoS ONE

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Recently, tissue-based methods for proteomic analysis have been used in clinical research and appear reliable for digestive, brain, lymphomatous, and lung cancers classification. However simple, tissue-based methods that couple signal analysis to tissue imaging are time consuming. To assess the reliability of a method involving rapid tissue preparation and analysis to discriminate cancerous from non-cancerous tissues, we tested 141 lung cancer/non-tumor pairs and 8 unique lung cancer samples among the stored frozen samples of 138 patients operated on during 2012.Samples were crushed in water, and 1.5 µl was spotted onto a steel target for analysis with the Microflex LT analyzer (Bruker Daltonics). Spectra were analyzed using ClinProTools software. A set of samples was used to generate a random classification model on the basis of a list of discriminant peaks sorted with the k-nearest neighbor genetic algorithm. The rest of the samples (n = 43 cancerous and n = 41 non-tumoral) was used to verify the classification capability and calculate the diagnostic performance indices relative to the histological diagnosis. The analysis found 53 m/z valid peaks, 40 of which were significantly different between cancerous and non-tumoral samples. The selected genetic algorithm model identified 20 potential peaks from the training set and had 98.81% recognition capability and 89.17% positive predictive value. In the blinded set, this method accurately discriminated the two classes with a sensitivity of 86.7% and a specificity of 95.1% for the cancer tissues and a sensitivity of 87.8% and a specificity of 95.3% for the non-tumor tissues. The second model generated to discriminate primary lung cancer from metastases was of lower quality.The reliability of MALDI-ToF analysis coupled with a very simple lung preparation procedure appears promising and should be tested in the operating room on fresh samples coupled with the pathological examination.

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Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections

Abstract: Frozen section is a rapid and accurate tool in digestive surgery. Local adjustment of the organization of the Pathology Department could enhance the rapidity and the quality of pathology diagnoses.

Cited by 9 publications

References 22 publications

Rapid Diagnosis of Lung Tumors, a Feasability Study Using Maldi-Tof Mass Spectrometry

Rapid Diagnosis of Lung Tumors, a Feasability Study Using Maldi-Tof Mass Spectrometry

Laparoscopic Confocal Laser Microscopy Without Fluorescent Injection

MALDI-ToF Mass Spectrometry for the Rapid Diagnosis of Cancerous Lung Nodules

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