Intraoperative Histopathological Examination Research Articles

COVID-19 with Suspected Secondary Pyogenic Arthritis of the Hip: A Case Report and Literature Review

COVID-19 with Suspected Secondary Pyogenic Arthritis of the Hip: A Case Report and Literature Review

Diagnostic efficacy of intraoperative histopathological examination of lesions with unknown diagnosis suspicious for malignancy

ObjectiveIn this study, the efficiency of intraoperative histopathological examination (frozen section examination; FS) in patients operated per suspected lung malignancy was evaluated. MethodsThe data of 136 patients who underwent surgery in our clinic due to suspected lung malignancy between January 2020 and June 2021 was evaluated prospectively. ResultsThe FS was inconclusive in 7.3 % of the 136 patients. In contrast, the accuracy of differentiating between benign and malignant lesions was 99.2 %, while the rate of false negative was 0.8 % in 126 patients with a prediagnosis. FS examination led to an accurate diagnosis in 91.9 % of the 98 patients without a history of extrapulmonary malignancy (EPM), with a false negativity rate of 1 %, whereas a paraffin-embedded examination was recommended in 7.1 %. The accuracy of the FS was 98.9 % in 91 patients prediagnosed based on an FS, with a false negativity rate of 1.1 %. In the same group of patients, the FS examination was successful in establishing the subtype in 32.9 % of the patients with primary lung cancer (PLC), whereas the efficacy of the FS examination in determining the subtype was better in benign diseases (63.6 % vs 32.9 %, p = 0.009). The FS examination was unable to differentiate between benign and malignant lesions in 92.1 % of patients with EPM but differentiated between primary and metastatic lesions in 48.3 % of patients who had malignancy. Furthermore, FS examination successfully guided surgery in 89 patients with no history of EPM (90.8 %) and 20 patients (52.6 %) with a history of EPM. ConclusionAlthough FS is insufficient in subtyping lung cancers and distinguishing PLC and metastasis, it is an important and effective diagnostic approach with its overall ability to distinguish benign and malignant lesions and guiding surgical procedures.

Unveiling the potential application of intraoperative brain smear for brain tumor diagnosis in low-middle-income countries: A comprehensive systematic review.

Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The data was extracted, processed, and organized using Microsoft Excel. A total of 59 out of 553 articles screened were included in the final analysis. The sensitivity and specificity of the intraoperative smear of brain tumors were found to be over 90% in most studies. The PPV was consistently above 90% in 11 studies, reaching 100% in one study and the NPV varied, ranging from 63% to 100%, and the accuracy was found to be >80% in most studies. One recurrent theme in the majority of the included studies was that an intraoperative brain smear is a cost-effective, quick, accessible, and accurate method of diagnosing brain tumors, requiring minimal training and infrastructure. Intraoperative brain smear is a simple, rapid, cost-effective, and highly sensitive diagnostic modality for brain tumors. It can be a viable and accessible alternative to more traditional methods such as frozen sections and can be incorporated into neurosurgical practice in LMICs as a reliable and efficient diagnostic tool.

Actinomycosis of the pelvis minor involving the ovary, fallopian tube, bladder, rectum, sigmoideum and pelvic wall, mimicking a dispersed neoplastic process

<b>Introduction.</b> Actinomycosis is a disease caused by anaerobic Gramme positive bacterium <i>Actinomyces israeli</i>. This is a specific inflammation with characteristic pathomorphological changes (sulphur granules), which is accompanied by focuses of fibrosis and the formation of abscesses or fistulas. Actinomycosis may develop in any organ, but the most frequent localization involvs face and neck (63%), lungs (15%) and abdominal cavity, including pelvis minor (22%). Regardless of the observed decrease in the total incidence of actinomycosis in recent years, the number of cases involving the abdominal cavity and pelvis minor localization in the population of women who use intrauterine contraceptive devices (IUD) has increased. <b>Aim.</b> To present, on the basis of own experience, a case of multiorgan actinomycosis within the pelvis minor, as a disease which is too rarely considered in the differentiating diagnostic process in cases of tumour originating from the reproductive organ, urinary tract or alimentary tract. <b>Materials and methods.</b> This article discusses a case of actinomycosis of the pelvis minor, involving the left ovary and tube, bladder, rectum, sigmoideum and pelvic wall. It describes the diagnostic process preceding the surgery, the surgery itself, during which an intraoperative histopathological examination was performed, facilitating the final diagnosis and the application of penicillin therapy. Diagnostic problems involving actinomycosis and a significant role of intraoperative histopathological examination are emphasised. The relationship between pelvic actinomycosis and the application of intrauterine contraceptive device is highlighted. <b>Conclusions.</b> 1. Clinical picture of actinomycosis localized in the reproductive organ may be similar to that of a neoplastic process. 2. In the case of tumours of the pelvis minor of non-specific localization, associated with the application of intrauterine device as a contraceptive method, the possibility of actinomycosis should be considered. 3 Histopathological examination, performed intraoperatively or by biopsy before the surgical procedure, is decisive in the diagnostic process and subsequent treatment. 4. The evaluation of a diagnostic value of bacteriological cultures taken from the uterine cervix to detect anaerobic bacteria in the female population with an increased risk of infection caused by <i>Actinomyces israeli</i> requires further research performed on a large group of patients.

Sensitivity of KOH Mount in the Early Diagnosis of Fungal Infections of Nose and Paranasal Sinuses in COVID-19 Infected Patients Suspected with Mucormycosis

Introduction: Mucormycosis represents a group of life threatening infections caused by fungi of the order Mucorales especially in Coronavirus Disease 2019 (COVID-19). It is a highly invasive and rapidly progressive disease resulting in high grades of morbidity and increased mortality. Aim: To study the sensitivity of potassium hydroxide (KOH) mount in the early diagnosis of mucormycosis in COVID-19 infected patients. Materials and Methods: A prospective, longitudinal (single group) study was done in McGANN Teaching District Hospital, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, among the patients with high index of clinical suspicion of mucormycosis from May 2021 to August 2021. Specimen from the nasal cavity or the suspected lesion on hard palate, gums, skin was sent for KOH mount and fungal culture and also biopsy of the nasal mucosa sent for histopathological examination. The sample was sent both preoperatively and intraoperatively. The positive KOH report and its role in early diagnosis and management of mucormycosis suspected cases were assessed. Results: Out of 26 patients, 6 (23.1%) were females and 20 (76.9%) were males. COVID-19 positive suspected mucormycosis were 5 (19.2%) and post COVID-19 suspected mucormycosis were 21 (80.8%). Species isolated after processing the sample were rhizopus in 10 (38.5%), candida in 1 (3.8%), aspergillus in 1 (3.8%); while in 14 (53.8%) no organisms were isolated. Out of 26 patients KOH positive sample on the day of admission confirming with positive intraoperative histopathological examination were 10 (41.7%). Admission day fungal culture positivity was seen in (n=12, 46.2% ) and negativity in 14 (53.8%) cases. Intraoperative fungal culture was positive in 24 (92.3%) cases. There was 100% specificity for both fungal culture and KOH mount and sensitivity for KOH was 41.7% and 50% for fungal culture. False negativity rate for KOH was 58.3% and for fungal culture was 50%. Conclusion: The results of KOH mount can be obtained within an hour of sending nasal scrapping samples. Hence, it helps in making the early diagnosis and early initiation of treatment for suspected cases. But in the current study, even in patients presenting with high clinical suspicion of mucormycosis, the sensitivity of KOH mount on the day of admission to the hospital was 41.7%.In view of severe morbidity and mortality of mucormycosis, this sensitivity though less is of paramount importance in these patients because treatment can be started early.

Indocyanine green-guided sentinel lymph node mapping during laparoscopic surgery with vaginal cuff closure but no uterine manipulator for cervical cancer.

Lymph node metastasis is a critical prognostic factor in cervical cancer. Considering the potential complications of lymphadenectomy and desirability of avoiding systemic lymphadenectomy, accurate intraoperative prediction of the existence of lymph node metastasis is important in patients undergoing surgery for cervical cancer. We evaluated the feasibility and value of indocyanine green (ICG) use for sentinel lymph node (SLN) mapping during laparoscopic surgery performed for cervical cancer. This single-center cohort study included 77 patients undergoing a new laparoscopic radical surgery method with pelvic lymphadenectomy for early-stage cervical cancer. The surgery, performed without using a uterine manipulator, included creation of a vaginal cuff. Bilateral ICG-guided SLN mapping and rapid histopathological examination were performed, and results were analyzed in relation to final histopathologic diagnoses. The SLN pelvic side-specific detection rate was 93.5%, sensitivity (SLN-positive cases/SLN-detected pelvic lymph node-positive cases) was 100%, intraoperative negative predictive value (NPV) was 97.8%, and final pathological NPV was 100%. The detection rate was significantly lower for tumors ≥ 2cm in diameter than for tumors < 2cm in diameter. Micrometastases were missed by intraoperative examination in 3 cases. The high NPV suggests the feasibility and usefulness of ICG-based SLN mapping plus rapid intraoperative examination for identification of metastatic SLNs. Use of ICG-based mapping for intraoperative identification of SLNs in patients undergoing this new laparoscopic surgery method for early-stage cervical cancer was particularly effective for tumors < 2cm in diameter. However, incorporating a search for micrometastases into rapid intraoperative histopathologic examination may be necessary.

Intraoperative Label‐Free Photoacoustic Histopathology of Clinical Specimens

AbstractDuring cancer resection surgeries, intraoperative histopathologic examination of the surgical specimen is crucial for tumor margin identification. A conventional frozen‐section analysis requires complex tissue processing, which prolongs surgery and potentially introduces interpretation errors. Here, as a novel approach to label‐free intraoperative histopathology, a high‐speed reflection‐mode ultraviolet photoacoustic microscopy (UV‐PAM) system employing a waterproof 1‐axis microelectromechanical systems scanner is demonstrated. Label‐free nuclear imaging is photoacoustically verified using tissue sections excised from mice and humans. Moreover, by imaging clinical specimens from cancer patients and numerically quantifying the histopathologic results, it is successfully demonstrated that the proposed UV‐PAM system has great potential as an alternative intraoperative histopathology method with minimal tissue preparation processes.

Prospective evaluation of sentinel node navigation surgery in Japanese patients with low-risk endometrial cancer-safety and occurrence of lymphedema.

The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

Sentinel Lymph Node Biopsy after Neoadjuvant Treatment for Breast Cancer. The Validation Protocol.

Introduction: The identification and biopsy of the sentinel lymph node (SLNB) in breast cancer patients requiring neoadjuvant cytostatic treatment (NAC), with clinically negative lymph nodes following treatment, may be an effective method of de-escalation of axillary surgery. Materials and methods: This prospective study includes 47 cases of breast cancer stage IIB-IIIA, with NAC treatment and complete axillary clinical and imaging response, surgeries performed at Prof. Dr. Alexandru Trestioreanu Oncological Institute in Bucharest (IOB) by the same team. In all the cases, SLNB was employed using the radioactive tracer method. The SLNB technique with Tc99 radioactive tracer involves: - injection of the radioactive tracer and preoperative lymphoscintigraphy, - intraoperative identification of the sentinel node/ lymph nodes and their excisional biopsy, - intraoperative histopathological examination, in paraffin blocks, and immunohistochemistry of the lymph node (SLN). Results: SLN was identified in 46 of 47 cases. In 19 cases SLN was positive, and in 2 cases we recorded false negative results. All patients underwent standard axillary lymphadenectomy (back-up lymphadenectomy). The correlation between the intraoperative and paraffin histopathological examination of SLN with the paraffin and immunohistochemical examination of the rest of the axillary nodes (N-SLN) led to the following results: sensitivity 91% (19/ 21), specificity 100% (25/ 25), positive predictive value 100% (19/ 19), negative predictive value 93% (25/ 27). The accuracy of the method was 96% (44/ 46). SLN invasion was more common in patients with residual tumor 2 cm (vs T 2 cm) (p = 0.01), positive N-SLN (vs non-invaded N-SLN) (p = 0.003). N-SLNs were more frequently invaded when there was peritumoral lymphocyte invasion (vs. no invasion) (p = 0.01). Conclusions: SLNB in patients with breast cancer who require NAC, with clinically and imaging negative lymph nodes following treatment, has a high rate of specificity and an acceptable number of false negative results. Node invasion is more common in patients with residual tumors 2 cm, with lymphovascular invasion or with multicenter/ multifocal disease.

Is subareolar intraoperative biopsy still necessary to predict nipple involvement

To predict the occult tumor involvement of nipple-areola complex (NAC) using preoperative MR imaging and to investigate whether the intraoperative histopathological examination of the subareolar tissue is still necessary. Out of 712 patients submitted to nipple-sparing mastectomy (NSM) between 2014 and 2019, we selected 188 patients who underwent preoperative breast MRI. Breast MRI and intraoperative histopathological examination of the subareolar tissue were performed to predict NAC involvement at permanent pathology. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. Forty-three patients (22.9%) had tumor involvement of the NAC. At univariate analysis, non-mass enhancement type (p = 0.009), multifocality/multicentricity (p = 0.002), median tumor size (p < 0.001), median tumor-NAC distance measured by MRI (p < 0.001), tumor-NAC distance ≤ 10 mm (p < 0.001) and tumor-NAC distance ≤ 20 mm (p < 0.001), and lymphovascular invasion (p = 0.001) were significantly correlated with NAC involvement. At multivariate analysis, only tumor-NAC distance ≤ 10 mm retained statistical significance. The sensitivity and specificity of MRI tumor-NAC distance ≤ 10 mm were 79.1% and 97.2% and those of intraoperative pathologic assessment were 74,4% and 100%, respectively. Tumor-NAC distance is the only reliable MRI characteristic that can predict NAC involvement in breast cancer patients. Although several cut-offs showed promising performances, intraoperative pathologic assessment is still mandatory.

Intravascular Fasciitis of the Femoral Vein Mimicking Thrombosis and Sarcoma

A 42 year old woman presented with swelling and pain of the left lower limb. Laboratory tests were unremarkable. Ultrasonography indicated left common femoral venous “thrombosis”. Venography revealed segmental vein occlusion. Computed tomography revealed an enlarged femoral vein with a hypodense mass. Magnetic resonance showed a 2.7 × 1.4 × 1.5 cm well enhanced mass (A, arrow). Intra-operative histopathological examination reported spindle cell sarcoma. Complete resection and reconstruction with great saphenous vein was performed. However, intravascular fasciitis was considered based on immunohistochemistry (smooth muscle actin positive but desmin negative), and was confirmed by fluorescence in situ hybridisation for ubiquitin specific protease 6 rearrangement (B, separation of green and red signals in blue nuclei).Image 1

Accuracy of Alvarado Scoring System and Selective Computed Tomography in Diagnosis of Suspected Cases of Acute Appendicitis

Objective: To evaluate the diagnostic accuracy of combined Alvarado scoring system and selective computed tomography (CT) in the diagnosis of suspected cases of acute appendicitis. Material and methods: This study was conducted during the period March 2018 to January 2020 at Prince Mohammed bin Abdul-Aziz hospital (NGHA) in Al Madinah, KSA. It is a prospective study involving 100 consecutive patients attending the emergency department with right iliac fossa pain, excluding children below the age of 14 years and pregnant women. All patients were initially assessed by the Alvarado scoring system, and the result of each patient was recorded in a separate predesigned data sheath. Based on the patient's calculated Alvarado scores, patients were stratified into three groups: Group A (score ≤ 4), Group B (score 5-6), and group C (score ≥ 7). All patients in group A were discharged from the emergency department with instruction to return if their symptoms persist or get worse while all patients in group B had an abdominal multidetector CT scan (MDCT) with IV contrast and no oral contrast to help the diagnosis. Group C patients had surgery without further investigation. Alvarado scores were compared to intraoperative findings and histopathological examination of the removed appendix in those who were operated. The sensitivity, specificity, positive and negative predictive values of the scoring system in each group were calculated with special reference to the role of CT scan in improving the diagnostic accuracy of the scoring system in the middle group (group B). Result: 58 patients were male and 42 were female. Age range between 14 and 43 years with median age 24 years. Out of the 100 patients, 14 (8 males, 6 females) belonged to Group A, 23 (11 males, 12 females) to Group B and 63 (39 males, 24 females) to group C. Two patients from group A (one male and one female) were returned with worsening symptoms and subsequently operated for acute appendicitis. CT scan established the diagnosis of acute appendicitis in 16 out of the patients of group B with subsequent histological confirmation of acute appendicitis in 15 of them. Histopathology confirmed the diagnosis of acute appendicitis in 32 out of 63 patients of group C. Conclusion: Alvarado score has a high accuracy of ruling in and out acute appendicitis at the extremes of the score (≤7 and ≥4), however, the accuracy of the score to confirm or rule out acute appendicitis in the middle group (5 -6) is significantly low. Selective utilization of CT scan in patients in the middle of the score improves the diagnostic accuracy of the score and limits overutilization of CT scan in the other patients at the extremes of the score saving patients unnecessary exposure to radiation and health authorities’ time and cost without increasing the rate of negative appendectomy.

Synchronous Primary Ovarian and Endometrial Carcinomas in a Young PatientCase report and literature review

Synchronous primary ovarian and endometrial carcinomas is a rare condition encountured in clinical practice, especially in young patients with history of endometriosis. The most frequent histopatological subtype is endometrioid carcinoma. We present a case of a 36-years old patient admitted in the Emergency Department for lower abdominal pain and abnormal uterine bleeding. The clinical and ultrasound examination diagnosed bilateral ovarian cystic tumors, a normal uterine structure and no abdominal fluid colection. Serum levels of ROMA score was performed with normal value. The International Ovarian Tumor Analysis (IOTA) criteria used for ovarian tumors scoring diagnosed a 55% probability for malignant tumors. Laparotomy was performed with prelevation of peritoneal fluid for citology. After right anexectomy was performed, the intraoperative histopathological examination diagnosed endometrioid ovarian carcinoma. Left anexectomy and total hysterectomy with omentectomy and multiple peritoneal biopsy was further performed. The final histopathological examination confirmed endometroid carcinoma in both ovaries and endometrial tissue. Keywords: synchronous genital carcinomas, endometrioid subtype, endometriosis

A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

Introduction: Nesidioblastosis is a hyperplasia of the beta cells that causes persistent hyperinsulinemic hypoglycemia, unfortunately, it is difficult to diagnose through imaging studies. Case presentation: A 68-year-old woman with palpitations, diaphoresis, dizziness and alterations in the level of consciousness that improve with food intake. Laboratories: glucose 35.0 mg/dl, insulin 12.5 mUI/ml, proinsulin 14.1 pmol/L and peptide C 2.55 ng/ml. Octreoscan reveals an abnormal epigastric uptake area and the tomography shows a focal hypervascular lesion in pancreatic body of 12×11 mm. A distal pancreatectomy was performed without palpating the tumor in transoperative period, and a diffuse nesiodioblastosis was reported in the histopathological study. The patient persists with hypoglycemia and an additional pancreatic resection was performed, resecting 90% of the organ. Although an insulinoma was not located in the piece, an area surrounded by connective tissue was observed where islet hyperplasia was more accentuated. Discussion: The pathophysiology of nesidioblastosis is unknown, its main differential diagnosis is insulinoma and this should be suspected when the tumor can not be identified. Most agree that a pancreatectomy that involves 60-80% of the total organ can control glucose levels with low risk of diabetes and pancreatic insufficiency. Conclusion: The nesidioblastosis should be suspected when a hyperinsulinemic hypoglycemia is difficult to control and when a tumor can not be identified. The extension of the pancreatectomy should be individualized and if an insulinoma is not localized and a nesidioblastosis is suspected, an intraoperative histopathological examination with frozen section evaluation for the margins could determine the extent of pancreatectomy.

PATH-31. BUILDING A RAMAN SPECTROSCOPY REFERENCE DATABASE FOR TUMOR IDENTIFICATION AND CLASSIFICATION

Abstract Brain tumor resection requires careful assessment of the nature and malignancy of the tumor tissue during intervention, as this is the basis for the decision as to how radical surgery has to be. Typically, there is no tissue available for analysis prior to the surgery. Intraoperative histopathological examination of tumor samples is time consuming and puts the patient to a significant amount of strain due to ongoing anesthesia and prolonged surgery, thus there is a need to develop faster methods for thorough diagnostics. Raman spectroscopy allows for a fast analysis of samples without the need for labeling and sample preparation, making it a useful tool for peri- and intrasurgical application. We collect Raman spectra and correlated histopathological results to build a database of different tumor types. As intrasurgical use of Raman spectroscopy will typically be applied to native specimens, the respective database has to be based on native samples as well. We collected several thousands of measurements from more than 100 patients and continue to assemble a native database. Tumors that do not occur with a high frequency are not sufficiently represented in the database. Therefore, we investigate whether it is possible to integrate fixed and frozen specimens in the collection of Raman spectra and the classifier. Fixation results in characteristic changes to the biochemistry of biological tissues. We collect pairs of spectra from native and fixed as well as from native and frozen specimens and use the difference of the spectra to create an algorithm for filtering of the specific changes in the spectra. These data can be used to train a classifier for the identification of native samples. This opens the way for assessing large collections of pathological samples in fixed and frozen state to cover any type of neoplastic disease in the database.

Unexpected Gallbladder Cancer during or after Laparoscopic Cholecystectomy: Risk Factors and Experience of Diagnosis and Treatment of 22 Cases

This study aims to provide some experience in diagnosis and treatment of unexpected gallbladder cancer (UGBC) and find the major risk factors. Retrospective data were collected and analyzed on 22 patients who were diagnosed with UGBC during or after laparoscopic cholecystectomy from January 2013 to January 2018 at our hospital. Average age of the patients was (60.2 ± 12.8) years (range, 42-83 years). Among them, there were 6 men and 16 women. Gallbladder stones, atrophic gallbladder, uneven thickened wall of the gallbladder, and choledocholithiasis were found to be the major risk factors. Eight patients (36.4%) were diagnosed intraoperatively. Seven cases (31.8%) were at the T1 stage; of these, three were treated with laparoscopic cholecystectomy; two were converted to cholecystectomy; and two underwent cholecystectomy, lymph node dissection, and liver resection. Eight (36.4%) T2 patients, five (22.7%) T3 patients, and one T4 patient had radical cholecystectomy. Partial cholecystectomy and cholecystotomy were carried out in another T4 patient. T1 patients did not receive chemotherapy or radiotherapy. Eleven had chemotherapy and four received chemoradiotherapy. The follow-up period ranged from six months to five years. The one-year survival rate for T1 to T4 patients was 100 per cent, 75 per cent, 40 per cent, and 0 per cent, respectively. A high index of clinical suspicion of UGBC is needed if one patient suffered from both gallbladder stones and choledocholithiasis with atrophic gallbladder or uneven thickened wall of the gallbladder preoperatively. To avoid more UGBC and reoperation, imaging examinations combined with tumor marker tests and intraoperative histopathologic examination are highly recommended.

Intraoperative evaluation of polymorphonuclear leukocyte during second-stage revision surgery promote overdiagnosis of persistent periprosthetic joint infection

ObjectiveThe aim of this study was to evaluate whether intraoperative histopathological examination could predict the risk of relapse of infection in periprosthetic joint infections (PJI). MethodsThe study included 25 patients (14 women and 11 men, with a mean age of 67.0 years (range, 37–83 years)), who had two-staged revision surgery for a PJI. Following prosthetic removal in the first stage, all patient underwent an intraoperative histopathological examination during the second stage. The patients were divided into PMNs-positive group (≥five PMNs per high-powered field) or -negative group (<five PMNs). A relapse was defined as the occurrence of PJI. Median follow-up was 51 months (range, 32–80 months) following second-stage revision surgery. ResultsIntraoperative histopathological revealed that 8.0% of cases were PMNs-positive. Postoperative histopathological examination revealed that 28.0% of cases were PMNs-positive. 28.0% of cases showed discrepancy between the PMNs-positivity. Intraclass correlation coefficient indicates poor reproducibility. Infection relapse after revision surgery occurred in two cases (8.0%); both relapse cases were from the PMNs-negative group. There was no statistical relationship between the presence of PMNs in periprosthetic tissue by intraoperative or postoperative histopathological examination and relapse of infection. ConclusionsOur findings showed that intraoperative histopathological examination could not predict the relapse of infection. Intraoperative histopathological examination promotes overdiagnosis of the requirement for re-implantation of antibiotic-impregnated cement and prolonged treatment periods. Level of evidenceLevel III, diagnostic study

The current application of ACOSOG Z0011 trial results: Is further implementation of sentinel lymph node intra-operative histopathological examination mandatory in breast cancer patients - a single-centre analysis.

The main objective of the ACOSOG Z0011 trial was to determine the impact of abandoning complete axillary lymph node dissection (ALND) on survival of breast cancer patients with sentinel node lymph (SLN) metastasis in whom breast conserving therapy (BCT) had been performed. The aim of our study was to assess the clinical value of intra-operative histopathological examination of SLN. Our study comprised 1284 invasive breast cancer patients in whom sentinel lymph node biopsy (SLNB) was carried out. SLN intra-operative histopathological assessment was routinely performed in patients treated within the first period (07.2013-06.2014). However, the decision regarding intra-operative assessment was made by the surgeon for the patients who underwent this evaluation in the later period 07.2014-06.2015 and were submitted for BCT. BCT was performed in 72.4% of patients. In total, 316 patients (24.6%) developed SLN-metastasis. Within the period 07.2014-06.2015, SLN intra-operative microscopic evaluation was performed in 20.8% of patients submitted for BCT. ALND was omitted in 27.5% of patients demonstrating SLN metastasis, in comparison with 15.5% of the group from the previous period (p=0.0094). The proportion of patients demonstrating macrometastasis in SLN who received conservative treatment to the axilla increased from 5.4% to 23.1% (p=0.0007). The choice of SLN final histopathological assessment may allow for deferral of decision on more extensive surgery of the axilla in patients submitted for SLNB. The omission of routinely-performed SLN intra-operative histopathological evaluation has led to a statistically significant increase in the proportion of patients in whom complete ALND was avoided.

P3013Combination of intraoperative electroanatomical mapping and histopathological examination revealed mechanism of monomorphic ventricular tachycardia associated with primary cardiac tumor

P3013Combination of intraoperative electroanatomical mapping and histopathological examination revealed mechanism of monomorphic ventricular tachycardia associated with primary cardiac tumor

Intralobar pulmonary sequestration complicated by gastric duplication

Abstract We experienced the case of an eight-month-old male with intralobar pulmonary sequestration complicated by gastric duplication. The chief complaint was an abnormal shadow on the chest radiograph; the patient was diagnosed with pulmonary sequestration via chest computed tomography (CT). Intraoperative findings and postoperative histopathological examination revealed intralobar pulmonary sequestration with associated gastric duplication. Pulmonary sequestration is relatively rare; although there are reports of extralobar pulmonary sequestration with gastric duplication, the present case of intralobar pulmonary sequestration with gastric duplication is extremely rare. This case is considered to be an embryologic bronchopulmonary foregut malformation, and is considered important in understanding the aetiology.