Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis

Miyamoto, Hiroshi

doi:10.1111/pin.13132

Cited by 7 publications

(3 citation statements)

References 74 publications

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“…Intraoperative frozen section analysis is a more accurate detection method and a key tool for BCS ( 9 ). However, it has disadvantages such as being time-consuming and labor-intensive ( 11 , 29 ). Previous studies have shown that the use of ICG can be used to identify tumors and normal tissues in colon cancers ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery

Yu,

Yao,

Zhu

et al. 2024

Gland Surg

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Background Fluorescence-guided surgery (FGS) is a cutting-edge technology that uses near-infrared (NIR) fluorescence imaging to guide surgeons in surgery. Indocyanine green (ICG) is a fluorescent dye, which can be used for in vivo imaging of tumor cells. We aimed to explore the use of ICG fluorescence-guided technology as a rapid intraoperative margin assessment method for breast cancer surgery. In addition, we also compared the dose selection of ICG. Methods This was a non-randomized prospective cohort study. Data were collected between August 2021 and October 2022 in the Division of Breast Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University. Upon specimen removal, tumor margins were immediately analyzed by ICG fluorescence detection and then sent to the pathology department for intraoperative frozen section analysis and subsequent routine pathological examination. Abnormal margin rates were calculated and compared using intraoperative frozen section analysis and under the guidance of ICG fluorescence. Results The study included 69 cases of breast cancer patients who underwent tumor resection assisted by ICG fluorescence-guided technology, including 18 patients with a 0.5 mg/kg dose and 51 patients with a 1.0 mg/kg dose. According to the study findings, the ICG test achieved a sensitivity of 81.82% and a specificity of 75.82%. At a dose of 0.5 mg/kg, the sensitivity was 66.67% whereas the specificity was 93.33%. At the dose of 1 mg/kg, the sensitivity was 87.5%, and the specificity was 74.42%. Similarly, for intraoperative frozen section analysis, the sensitivity was 81.82%, but the specificity was enhanced to 94.83%. Positive surgical cut margin was not identified in 2/69 by ICG fluorescence and frozen section analysis respectively. Conclusions The sensitivity of ICG fluorescence detection is comparable to that of frozen section analysis, but the specificity is poor. The sensitivity increased and the specificity decreased at 1 mg/kg compared to the 0.5 mg/kg dose. ICG fluorescence can be used as a supplementary tool for frozen section analysis. These findings support further development and clinical performance assessment of ICG fluorescence.

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Section: Discussionmentioning

confidence: 99%

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery

Yu,

Yao,

Zhu

et al. 2024

Gland Surg

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“…Meanwhile, a few studies ( 8 , 11 , 12 , 15 , 18 , 22 , 25 , 26 , 30 , 31 , 36 , 38 ) have mentioned the use of frozen section assessment (FSA) in surgery. However, Miyamoto’s ( 58 ) study suggested that the diagnostic accuracy of FSA in partial nephrectomy and its impact on the status of the incision margin had not been determined. They did not believe that FSA will benefit patients.…”

Section: Discussionmentioning

confidence: 99%

Positive surgical margins may not affect the survival of patients with renal cell carcinoma after partial nephrectomy: A meta-analysis based on 39 studies

et al. 2022

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BackgroundSo far, whether positive surgical margin(PSM) has adverse effects on the prognosis of patients is still controversial, so we designed this study to systematically evaluate the effect of PSM on the prognosis of patients with renal cell carcinoma (RCC) after partial nephrectomy (PN).MethodsOn the basis of three electronic databases (PubMed, Embase and the Cochrane Library) up to May 2022, all case–control studies (CCSs) comparing the effects of PSM and negative surgical margin (NSM) after PN on the oncological results of RCC patients were included. Two evaluators independently conducted a systematic literature search and extracted the data we needed. The methodological quality of all studies was evaluated by the modified Newcastle–Ottawa scale. The odds ratio (OR) was used to describe the results for dichotomous variables, and the meta-analysis was conducted using Cochrane Review Manager 5.2 and Stata 14.2.ResultsA total of 39 studies involving 21461 patients were included in our meta-analysis. The pooled results showed that the rates of tumor recurrence (OR 3.93, 95% CI 2.95-5.24; p < 0.00001) and metastasis (OR 4.63, 95% CI 3.11-6.88; p < 0.00001) in the PSM group were significantly higher than those in the NSM group. However, there were no significant differences in the rates of all-cause death (OR 1.35, 95% CI 0.92-1.99; p = 0.13) or cancer-specific death (OR 0.99, 95% CI 0.51-1.94; p = 0.99) between the two groups. In addition, subgroup analyses were carried out according to different average follow-ups, which revealed similar results.ConclusionInsignificant differences in survival between the PSM and NSM groups were observed, although significant differences in recurrence and metastasis in the PSM group were reported. Our study supported that close monitoring might be another effective choice for patients with PSM after PN. Considering the possible limitations, we recommended cautious interpretation of our results.

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“…Current techniques for evaluating margin statuses, such as frozen section, imprint cytology, and intraoperative ultrasound, are very useful tools for precision surgery but expensive in terms of time and costs and not always available to surgeons. Furthermore, not all hospitals have experts in the use of this instrumentation applied to tumours [ 5 , 6 ]. However, there is a clinical need for safe and accurate approaches to defining tumour margins intraoperatively [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Image-guided cancer surgery: a narrative review on imaging modalities and emerging nanotechnology strategies

et al. 2023

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Surgical resection is the cornerstone of solid tumour treatment. Current techniques for evaluating margin statuses, such as frozen section, imprint cytology, and intraoperative ultrasound, are helpful. However, an intraoperative assessment of tumour margins that is accurate and safe is clinically necessary. Positive surgical margins (PSM) have a well-documented negative effect on treatment outcomes and survival. As a result, surgical tumour imaging methods are now a practical method for reducing PSM rates and improving the efficiency of debulking surgery. Because of their unique characteristics, nanoparticles can function as contrast agents in image-guided surgery. While most image-guided surgical applications utilizing nanotechnology are now in the preclinical stage, some are beginning to reach the clinical phase. Here, we list the various imaging techniques used in image-guided surgery, such as optical imaging, ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine imaging, and the most current developments in the potential of nanotechnology to detect surgical malignancies. In the coming years, we will see the evolution of nanoparticles tailored to specific tumour types and the introduction of surgical equipment to improve resection accuracy. Although the promise of nanotechnology for producing exogenous molecular contrast agents has been clearly demonstrated, much work remains to be done to put it into practice. Graphical Abstract

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Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis

Cited by 7 publications

References 74 publications

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery

Positive surgical margins may not affect the survival of patients with renal cell carcinoma after partial nephrectomy: A meta-analysis based on 39 studies

Image-guided cancer surgery: a narrative review on imaging modalities and emerging nanotechnology strategies

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