Intraoperative Diagnostik des Pankreascarcinoms

Abstract

Between 1978 and 1981 634 frozen section examinations were performed during 185 operations on patients with pancreatic or periampullary carcinoma. The frozen section findings and the definite reports after paraffin embedding were identical in 97.2% of all examinations. 1.6% of frozen section findings were false negative, 0.2% false positive. The positive predictive value, especially important for the surgeon, was 100% for examinations of the pancreas and the primary tumor and 98.9% for metastases and structures suspicious of metastases. The negative predictive value was 94.3% and 99.6% respectively. Serious complications of pancreatic biopsies were not observed. On 438 pancreatic resection specimens after intraoperative frozen section examination a benign disease was diagnosed between 1971 and 1981. By further work-up after paraffin embedding at another institution a carcinoma was detected surprisingly only in two cases (0.5%). A pancreatic resection based on a false positive frozen section finding was never performed. The results prove that intraoperative frozen section examination is a useful and reliable diagnostic procedure. A review of the recent literature demonstrates as well that similar results cannot be achieved by other methods including intraoperative fine needle aspiration biopsy.

Frozen Section Interpretation of Pancreatic Margins

“…The false positive frozen diagnosis in our study was 2.2% for the 2 GI pathologists, and this finding is in accordance with previously reported false positive FS rates of 0% to 3%. 20,25-27,30,31 However, the false positive diagnosis of our 2 general pathologists was higher (12.5%). Part of the reason for this could be that the general pathologists may have a low threshold for calling anything that looks remotely suspicious as atypical as a safeguard procedure to get an additional pancreatic parenchymal margin resection, wherever surgically feasible.…”

“…These are comparable to the findings reported in previous studies. 20,25-27,30,31 Also, both subspecialized GI and general pathologists performed better at identifying true negatives as compared to true positives.…”

“…The accuracy is similar to previously reported accuracies around 90%. 20,25-28 Misinterpretation of FSs, both in false positive and false negative directions, is not uncommon due to a number of technical factors. The inevitable cautery and freezing artifacts are usually encountered.…”

Frozen section diagnosis of pancreatic malignancy: A sensitive diagnostic technique

“…Whilst diagnosis of benign disease may prevent unnecessary resection, the sensitivity of the procedure has been an area of contention [4][5][6][7] . Other groups have confi rmed a close correlation between diagnosis on frozen section material and that made later from permanent sections from the same biopsy, with concordance in the region of 97-98% of cases reported [3,8] . Our study demonstrates that frozen section analysis is very reliable in the assessment of pancreatic lesions, with a low false-negative rate of 1.9%.…”

Improvement of Intraoperative Frozen Section Diagnosis in Patients with Biliary Strictures by Levovist Injection into the Bile Duct on Color Doppler Ultrasonography

“…Diagnosis by surgeons based on inspection and palpation of the pancreas intraoperatively was reported to be erroneous in 7% to 18% of follow-up patients [12], and c-IPB reduced those false-negative cases without imposing serious complications [12,15]. Yet even c-IPB produced false-negative rates of 0.2% to 4.0% [12][13][14][15]. Although c-IPB in our study was particularly helpful for the differential diagnosis of an indistinct mass in the head of the pancreas, false-negative frozen sections were found in two cases: a bile duct carcinoma that had not been confirmed by preoperative cytologic examination and a small pancreatic tumor adjacent to biliary strictures that had not been depicted by several previous images.…”