Intraoperative Frozen Section Biopsy Research Articles

166 (PB-073) Poster - Can we omit intraoperative frozen-section biopsy during breast-conserving surgery in selected patients?

166 (PB-073) Poster - Can we omit intraoperative frozen-section biopsy during breast-conserving surgery in selected patients?

Evaluation of Resection Margin by Intraoperative Frozen Section Biopsy in Breast Conservative Surgery for Early Breast Carcinoma

Background: Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. Aims: To evaluate the resection margin by intra-operative frozen section in breast conserving surgery for early breast carcinoma. Methods: This cross sectional study was carried out in the department of general surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 20 patients with early stage breast carcinoma underwent surgery were included in this study. Admitted patients with diagnosis of invasive ductal carcinoma of the breast, patient who gave consent for research purpose, patients diagnosed with stage I & II breast cancer, small (up to 4 cm) unifocal tumor and clinically negative axillary nodes were enrolled in this study. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: It was observed that more than one third (40.0%) patients belonged to age 41-50 years. The mean age was 45.55±10.94 years with ranged from 28 to 75 years. Half (50.0%) patient’s educational level was primary. Majority (85.0%) patient’s occupational statuses were housewife. Majority (90.0%) patients had lump size >2-≤5 cm. The mean lump size was 2.89±0.66 cm with ranged from 1.5 to 4 cm. Three fourth (75.0%) patients had lump in the right breast. Almost two third (60.0%) patients had lump in the upper outer quadrant of breast. Two (10.0%) patients had Grade I and 18(90.0%) had Grade II tumor. Three fourth (75.0%) patients had resected tumor of T2 >2-≤5 cm size. The mean size of resected toumour was 2.65±0.62 cm with ranged from 1.4 to 3.8 cm. The frequency of positive resection margin on frozen section was 3 (15%). Among them 1 (33.3%) patient had positive superior margin and 2 (66.7%) had positive lateral ....

Expanded indications for breast-conserving surgery with oncoplastic approaches compared to conventional approaches: a single-center retrospective comparative cohort study.

Oncoplastic breast-conserving surgery (OPBS) is the evolution of conventional breast-conserving surgery (CBCS); however, data from studies comparing patients who received two surgical procedures are limited. A comparison of differences in terms of the patient characteristics, tumor-nipple distance, volume of resected breast tissue, tumor volume and postoperative breast appearance between patients undergoing OPBS and CBCS was carried out in this study, enhancing the evidence base for OPBS by widening indications and improving patient satisfaction. From January 2020 to April 2022, the Breast Center of West China Hospital conducted a retrospective comparative study involving 106 patients. Preoperative characteristics of patients were recorded, and the tumor-nipple distance, the volume of resected breast tissue, tumor volume and patient-reported esthetic outcomes measured by the Harris cosmetic scale were compared between patients who underwent OPBS and CBCS. Each group had a median follow-up time of 2 months, ranging from 1 week to 6 months. The tumor-nipple distance was significantly shorter in patients receiving OPBS than in those receiving CBCS (2.98±1.42 vs. 3.85±1.78 cm, P=0.006). The rate of positive margin evaluated by intraoperative frozen section biopsy was significantly lower in OPBS group than in CBCS group (2/43, 4.65% vs. 11/63, 17.46%; P=0.048). The maximum diameter of resected tissue (7.80±2.29 vs. 6.75±1.87 cm, P=0.011) and volume of resected tissue (74.20±42.77 vs. 45.52±30.99 cm3, P<0.001) were significantly larger with OPBS. The tumor size, tumor volume (either clinically measured by ultrasound or pathologically measured), tumor location, and reoperation rate due to positive margins did not differ significantly between groups. Moreover, insignificant differences existed regarding patient satisfaction between two groups (87.30% vs. 81.40%). The OPBS strategy allowed extensive resections and expanded indications with equivalent cosmetic satisfaction and favorable oncological safety.

Intra Testicular Leiomyoma: First Case Report from an Ethiopian Patient

Leiomyomas are benign tumors arising from smooth muscle cells myometrium being most common site of origin. Capsule of kidney is most common site of origin in male Genito urinary system. Testicular parenchyma is an extremely rare site where tumor presents as a painless, slowly growing mass. It is very difficult to diagnose this lesion preoperatively as ultrasound features are nonspecific. Microscopic evaluation only renders an exact diagnosis. Intraoperative frozen section biopsy followed by local excision is the current treatment of choice but if not available radical orchidectomy would be done. We report case of intratesticular leiomyoma in a 32-year-old Ethiopian patient.

US Features of the Parathyroid Glands: An Intraoperative Surgical Specimen Study.

This study aimed to evaluate the US features of the parathyroid glands (PTGs) using surgical specimens of normal PTGs obtained during thyroid surgery. This study included 34 normal PTGs from 17 consecutive patients who underwent thyroid surgery between December 2020 and March 2021. All normal PTGs were histologically confirmed by intraoperative frozen-section biopsy for autotransplantation. Surgically resected parathyroid specimens were scanned in sterile normal saline using high-resolution US prior to autotransplantation. The US features of echogenicity (hyperechogenicity or hypoechogenicity), echotexture (homogeneous or heterogeneous), size, and shape (ovoid or round) were retrospectively evaluated. The echogenicity of the three PTGs was compared with that of the thyroid parenchyma of the resected thyroid specimens in two patients. All PTGs showed hyperechogenicity similar to that of gauze soaked in normal saline. Homogeneous hyperechogenicity was observed in 32/34 (94.1%) patients, and the echogenicity of the three PTGs was hyperechoic compared with that of the thyroid parenchyma. The long diameter of the PTGs ranged from 5.1 mm to 9.8 mm (mean, 7.1 mm) and the shape of the PTGs was ovoid in 33/34 (97.1%) patients. The echogenicity of normal PTG specimens was consistently hyperechoic, and the small ovoid homogeneously hyperechoic structure was a characteristic US feature of the PTGs.

Role of Intra-Parotid Lymph Node Metastasis in Primary Parotid Carcinoma.

The parotid gland contains intra-glandular lymph nodes, the distribution of which is crucial for understanding the pathogenesis of intra-parotid lymph node metastases of parotid carcinoma and other head and neck carcinomas. Positive intra-parotid lymph node metastasis predicts the risk of positive cervical nodal metastasis. It is important to establish whether prophylactic neck dissection, including intra-parotid lymph nodes, contributes to treatment outcomes. The presence or absence of intra-parotid lymph nodes or metastasis-positive lymph nodes warrants further study. A preoperative diagnosis by imaging and fine-needle aspiration cytology of intra-parotid lymph nodes is difficult. Although intraoperative frozen section biopsy is performed during surgery, it is challenging to identify intra-parotid lymph nodes. The number of lymph nodes was the largest (47%) in the lower half of the superficial lobe, with 35% of nodes being concentrated in the inferior part of the cervicofacial branch, i.e., the lower pole of the parotid gland. Therefore, superficial parotidectomy and lower pole lobectomy need to be performed in cases in which a malignant tumor localizes to the superficial lobe or a lower pole. When intra-parotid lymph node metastases are detected during surgery, selective neck dissection (at least levels II and III) needs to be simultaneously performed.

Frozen section biopsy for tumors of the submandibular triangle

Diagnosis and treatment of submandibular lesions is challenging. Carcinomas, which frequently occur, should be surgically removed with sufficient safety margins, while simultaneously protecting functional structures. In particular, the preservation of neuronal structures with simultaneous tumor control suggests that single-stage concepts are appropriate, although they are not yet established. The aim of this study was to evaluate intraoperative frozen section biopsy as apossible basis for aone-stage surgical concept to thus prevent functional alterations by reoperation. Atotal of 114consecutive patients with neoplastic lesions in whom the type of lesion could not be determined after ENT examination and imaging were included in the study. Patients with aknown history of carcinoma or evidence of an acute inflammatory or carcinogenic primary lesion in the ENT examination and/or imaging were excluded. An intraoperative frozen section biopsy was performed to determine the presence of acarcinoma. Patient-related data and the reliability of the frozen section result were recorded comparatively. Intraoperative frozen section biopsy was performed in atotal of 114patients. Carcinomas were diagnosed with asensitivity of 87% and aspecificity of 100%. There would thus not have been unnecessary radical surgery in aone-stage approach. In 26 of 30patients with carcinoma, asecond operation could have been avoided. Intraoperative frozen section biopsy is potentially an important method to histologically confirm carcinomas and avoid two-stage procedures. The absence of false-positive findings would have prevented an unnecessary radical procedure in 100% of patients.

A Systematic Review and Meta-analysis of Touch Imprint Cytology and Frozen Section Biopsy and Their Comparison for Evaluation of Sentinel Lymph Node in Breast Cancer.

Evaluation of axillary lymph nodes after sentinel lymph node biopsy (SLNB) in breast cancer is mostly done by intra-operative frozen section biopsy (FSB) and/ or touch imprint cytology (TIC). In this systematic review and meta-analysis, we have compared the accuracy of the two modalities. PubMed, EMBASE, and Cochrane electronic databases were searched for articles comparing TIC with FSB. Articles were assessed for methodological and reporting quality. The main summary measures were pooled sensitivity, pooled specificity, and diagnostic accuracy using bivariate generalized linear mixed models using random effects. Fourteen studies were included. The pooled sensitivity, specificity, and diagnostic accuracy for FSB were 78%, 100%, and 98.57%. For TIC, the pooled sensitivity, specificity, and diagnostic accuracy were 74%, 98%, and 98.37%. For both methods, visual inspection of summary ROC curves and of forest plots did not show significant heterogeneity. TIC showed comparable sensitivity, specificity, and accuracy to FSB and hence can be used as its substitute as a rapid and economical test for the detection of axillary lymph node metastasis during SLNB especially in low-resource settings.

Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section

BackgroundOver the past few decades, surgery for Hirschsprung’s disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglionic segment. However, this facility is not available in most low-income countries. Therefore, a two-stage procedure with an initial colostomy is still practiced in the developing world. We aimed to evaluate the outcome of single-stage transanal pullthrough performed in a facility without frozen section biopsy.MethodsA retrospective review of all patients who underwent transanal pullthrough in two teaching hospitals over a 6-year period (2015–2020).ResultsForty-seven children underwent transanal endorectal pullthrough (TERPT). Age at surgery ranged from 2 months to 6 years and mean weight was 8.7 kg. Barium enema did not show transition zone in 6 patients (12.8%) while others demonstrated short segment HD. Intraoperatively, the transition zone was visualized in 40 patients (85%). TERPT alone was performed in 35 (74.5%), TERPT with laparotomy to visualize transition zone in 9 (26.7%) and TERPT with transabdominal mobilization was required in 3 (6.4%). Definitive histopathologic examination revealed aganglionic segment pullthrough in 4 (8.5%) and transitional zone pullthrough in another 4 (8.5%). However, with long term follow up all eight children remained asymptomatic and no intervention was required.ConclusionsTransanal pullthrough offers reduced number of surgeries and faster recovery. We have also observed a good functional outcome despite a discrepancy with pathology results. Overall, our data suggests it is a safe and viable option for the treatment of short segment HD in facilities where frozen section is not available.

A retrospective analysis of 5-year post surgery recurrence of N0 neck and the role of methylene blue in sentinel lymph node biopsy

The aim of this study is to perform a retrospective analysis of the feasibility of the clinical application of SLNB using methylene blue dye (MBD) for the identification of SLN followed by frozen section biopsy to detect occult metastasis in clinically N0 necks. Hence, to know the reliability of MBD in reducing the need for extensive surgery. MethodsWe retrospectively analyzed the clinic pathological data of 48 patients with early oral cancer.The SLN identification rate (IR) was calculated in SLNB with MBD and the false-negative rate (FNR). Intra operative frozen section biopsy was done for all patients was compared with post-operative paraffin histopathology report and the prognosis of patients was analyzed. ResultsAnalysis of the 48 SLNB cases showed that there were significant differences in SLN successful detection rate among patients with different site (p = 0.043) and clinical presentation (p = 0.007). Similar significant results (p < 0.05) were observed with intra-operative frozen and post-operative paraffin histopathology sections. SLNs were successfully detected in 37(77.1%) patients out of 48. The intra operative frozen histopathology completely matched with the post-operative paraffin histopathology showing 39 (81.2%) negative and 09 (18.8%) positive cases. A prognostic analysis of SLN detection based on 48 patients showed that the 5-year survival rate was 100%. ConclusionMBD has acceptable SLN identification rate and a low FNR(false negative report) in frozen sections. Stained SLNs with no SLN metastasis are associated with disease-free survival (DFS). Hence, MBD-SLN biopsy has significantly reduced the need for extensive neck dissection in N0 neck with less morbidity.

Primary Fallopian Tube Carcinoma (PFTC), A Rare Malignancy of Female Genital Tract

Background: Primary fallopian tube carcinoma (PFTC) is one of the rarest malignancies of female genital tract. It represents &lt;1% of all gynecologic malignancies. Preoperative diagnosis is uncommon due to its rarity and non-specific symptoms. In most cases diagnosis is made during surgery or histological examination. Rarity of this type of carcinoma prompted us to report it as individual case. Case: A 40-yearold parous women presented with bilateral PFTC. The patient gave a history of lower abdominal and pelvic pain for 2 years on several occasions. An abdominal ultrasound finding showed an adnexal mass and her CA125 level was 30IU/ml (normal- &lt;35IU/ml). Clinically she was suspected as a case of pelvic inflammatory disease (PID). She underwent Total Abdominal Hysterectomy with bilateral salpingoophorectomy. Intraoperative findings were consistent with PID. Final pathologic analysis showed bilateral primary fallopian tube carcinoma —well differentiated serous adenocarcinoma. Post operatively she was referred for oncological management.&#x0D; Conclusion: Malignancy should be considered in the differential diagnosis of PID especially in premenopausal age and intraoperative frozen section biopsy is crucial to make correct diagnosis and to allow appropriate surgical staging.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(1): 49-52

Unexpected Para-aortic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: a Contraindication to Resection?

BackgroundMargin-negative resection is the only cure for pancreatic cancer. However, para-aortic lymph node metastasis is considered a contraindication to curative resection in pancreatic cancer. To determine if there are long-term survival differences according to the presence or absence of para-aortic lymph node metastasis in patients undergoing pancreatectomy, we evaluated oncologic outcomes in resected pancreatic cancer with unexpected para-aortic lymph node metastasis confirmed on intraoperative frozen section biopsy. MethodsWe retrospectively investigated 362 patients with pathologically confirmed pancreatic ductal adenocarcinoma who underwent pancreatectomy between 1996 and 2016. ResultsPatients with a metastatic para-aortic lymph node had the poorest median disease-specific survival [hazard ratio 14, 95% confidence interval 10–19]. However, after chemotherapy, patients with a metastatic para-aortic lymph node had a much higher disease-specific survival rate (para-aortic lymph node+/postoperative chemotherapy− versus para-aortic lymph node+/postoperative chemotherapy+, P = 0.0003, adjusted P = 0.0015). Patients with a metastatic para-aortic lymph node who underwent postoperative chemotherapy had a similar survival benefit to patients with metastatic regional lymph node without para-aortic lymph node metastasis, regardless of postoperative chemotherapy (para-aortic lymph node+/postoperative chemotherapy+ versus regional lymph node+/postoperative chemotherapy−, P = 0.3047, adjusted P > 0.9999; para-aortic lymph node+/postoperative chemotherapy+ versus regional lymph node+/postoperative chemotherapy+, P = 0.0905, adjusted P = 0.4525). ConclusionsUnexpected para-aortic lymph node metastasis on frozen section biopsy may no longer be a contraindication to curative resection in “resectable” pancreatic ductal adenocarcinoma, as long as postoperative adjuvant chemotherapy can be administered.

Omitting vs. Doing Intraoperative Frozen Section Biopsy for Margin Status in Breast Conserving Surgery

Omitting vs. Doing Intraoperative Frozen Section Biopsy for Margin Status in Breast Conserving Surgery

Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature.

BACKGROUNDTransduodenal ampullectomy (TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However, TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors, and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.AIMTo investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.METHODSTen patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions, and the endoscopic ultrasound (EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy, intraoperative frozen-section pathological examination, and postoperative pathological examination.RESULTSThis study included seven patients with benign tumors and three with malignant tumors (1 pTis, 2 pT1), according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100% (10/10), and the coincidence rate with the endoscopic biopsy results was 70% (7/10) based on pathological characteristics. The endoscopic biopsy false-negative rate was 30% (3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.CONCLUSIONThe coincidence rate of postoperative pathology results, intraoperative frozen-section pathology results, and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.

Diagnosis and treatment of unexpected gallbladder carcinoma: a multicenter retrospective study (A report of 223 cases)

Diagnosis and treatment of unexpected gallbladder carcinoma: a multicenter retrospective study (A report of 223 cases)

Chronic Cough Caused By an Intra-Abdominal Bronchogenic Cyst: A Case Report and Literature Review

Introduction: Bronchogenic cyst is an extremely rare congenital abnormality that is incidentally found by imaging during health check-up. They can hardly occur in the abdomen with unspecific symptoms or change in laboratory values. Case presentation: Here in, we are going to report a case of a 33 years old male patient who was admitted in our department for an intra-abdominal mass. Pathological result of the resected mass was bronchogenic cyst. Conclusion: In most of the cases, bronchogenic cysts are misdiagnosed. The use of endoscopic ultrasound guided fine needle aspiration, computed tomography guided needle biopsy or intraoperative frozen section biopsy is helpful in confirming their diagnosis and to choose the most appropriate treatment.

Ampullectomy versus pancreaticoduodenectomy for ampullary tumors

BackgroundConsiderable controversy surrounds the treatment of ampullary neoplasms. This report describes the authors' experiences regarding the choice of either ampullectomy or pancreaticoduodenectomy for treatment of ampullary tumors. MethodsDemographics, statistical findings concerning diagnosis, surgical risks including morbidity and mortality, and outcomes were evaluated and compared between the ampullectomy and pancreaticoduodenectomy groups for ampullary tumors retrieved from a prospectively collected computer database of 992 periampullary tumors resected during the period from 1965 to 2013. ResultsA total of 377 patients with ampullary tumors were included; 15 underwent ampullectomy and 362 underwent pancreaticoduodenectomy. The overall false-negative rate for diagnosis of ampullary malignancy was 11.2%, specificity was 50.0%, positive predictive value was 98.3%, negative predictive value was 12.2%, and the overall accuracy was 87.6% (77.5% by preoperative endoscopic biopsy and 83.9% by intraoperative frozen-section biopsy). Ampullectomy was associated with shorter postoperative stays and lower surgical morbidity. There was no statistical difference observed between the two groups regarding surgical mortality, pancreatic leakage, or gastric atonia. The tumor recurrence rate was lower after pancreaticoduodenectomy, but the difference between the groups was not significant. Overall, there was no difference in survival observed between the two groups. ConclusionBecause biopsy is not routinely reliable, pancreaticoduodenectomy is preferable to ampullectomy for an ampullary tumor of uncertain diagnosis. Ampullectomy is associated with lower surgical morbidity and should therefore remain in the armamentarium of the pancreatic surgeon when comorbidity precludes major surgery.

Liposarcoma in the axilla developed from a longstanding lipoma.

Liposarcoma in the axilla developed from a longstanding lipoma.

Abstract P5-15-04: Clinical benefits of using nomogram for predicting positive resection margins in breast conserving surgery

Abstract Achieving a clear resection margin in breast conserving surgery (BCS) is an important factor in tumor recurrence in breast cancer. To obtain clear resection margins and reduce re-excision rates, some surgeons obtain intraoperative assessments of the margins of excised specimens, using intraoperative frozen biopsy. But intraoperative frozen biopsy has several problems such as low sensitivity or longer operation time. We have previously reported a nomogram for prediction of positive resection margin by integrating preoperatively available clinical and pathologic information. The factors were the presence of microcalcification, mammographic density, tumor size discrepancy between magnetic resonance imaging and ultrasonography, and the presence of ductal carcinoma in situ or lobular carcinoma in needle biopsy specimens. We conducted a prospective trial to examine the accuracy and clinical benefits of the nomogram in 442 breast cancer patients (nomogram group) who underwent BCS between Dec 2011 and March 2013, and compared the clinical outcome with that of the 253 patients (control group) who underwent BCS between Jan 2011 and Oct 2011. For nomogram group, the intraoperative frozen section biopsy was omitted in patients with low nomogram scores. Applying our nomogram did not increase the rate of reoperation due to resection margin positivity when compared to the control group (6.56% vs. 4.25%, respectively, p = 0.22). In the nomogram group, the reoperation rate in patients with low nomogram score who did not undergo intraoperative frozen biopsy was 3.2%, and this is lower than the reoperation rate in the control group. Additionally, we experienced a significant reduction in operation time by 15 minutes when compared to the control group (p&amp;lt;0.001). In conclusion, our results show that out nomogram for predicting positive resection margin for patients who receive BCS can significantly reduce the operation time without increasing reoperation rate. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-15-04.

Diagnosis and treatment of renal oncocytoma of 6 cases and literature review

To improve the diagnosis and treatment of renal oncocytoma and avoid unnecessary radical nephrectomy. The clinical data of 6 cases of renal oncocytoma diagnosed at the Second Xiangya Hospital Central South University from March 2005 to November 2010, including symptoms, laboratory tests, imaging, style of operation, pathological examination, and follow-up were retrospectively analyzed.There were no special symptoms and obvious abnormal laboratory tests in the patients. Two patients had relatively special imaging. Partial nephrectomy was performed in 2 cases of renal oncocytoma with typical imaging, while radical nephrectomy was performed on other patients because of misdiagnosis. No relapse and metastasis were found in the following 1 to 5 years.Renal oncocytoma is an uncommon benign tumor. Partial nephrectomy or tumor excision can be performed on patients diagnosed with renal oncocytoma according to typical imaging and intraoperative frozen section biopsy. The final diagnosis depends on pathological examination and regular follow-up is imperative for patients with renal oncocytoma.