Intraoperative Pathological Diagnosis Research Articles

Accurate categorization and rapid pathological diagnosis correction with Micro-Raman technique in human lung adenocarcinoma infiltration level.

In the context of surgical interventions for lung adenocarcinoma (LADC), precise determination of the extent of LADC infiltration plays a pivotal role in shaping the surgeon's strategic approach to the procedure. The prevailing diagnostic standard involves the expeditious intraoperative pathological diagnosis of areas infiltrated by LADC. Nevertheless, current methodologies rely on the visual interpretation of tissue images by proficient pathologists, introducing an error margin of up to 15.6%. In this study, we investigated the utilization of Micro-Raman technique on isolated specimens of human LADC with the objective of formulating and validating a workflow for the pathological diagnosis of LADC featuring diverse degrees of infiltration. Our strategy encompasses a thorough pathological characterization of LADC, spanning different tissue types and levels of infiltration. Through the integration of Raman spectroscopy with advanced deep learning models for simultaneous diagnosis, this approach offers a swift, precise, and clinically relevant means of analysis. The diagnostic performance of the convolutional neural network (CNN) model, coupled with the microscopic Raman technique, was found to be exceptional and consistent, surpassing the traditional support vector machine (SVM) model. The CNN model exhibited an area under the curve (AUC) value of 96.1% for effectively distinguishing normal tissue from LADC and an impressive 99.0% for discerning varying degrees of infiltration in LADCs. To comprehensively assess its clinical utility, Raman datasets from patients with intraoperative rapid pathologic diagnostic errors were utilized as test subjects and input into the established CNN model. The results underscored the substantial corrective capacity of the Micro-Raman technique, revealing a misdiagnosis correction rate exceeding 96% in all cases. Ultimately, our discoveries highlight the Micro-Raman technique's potential to augment the intraoperative diagnostic precision of LADC with varying levels of infiltration. And compared to the traditional SVM model, the CNN model has better generalization ability in diagnosing different infiltration levels. This method furnishes surgeons with an objective groundwork for making well-informed decisions concerning subsequent surgical plans.

Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging

BackgroundCentral nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or leptomeninges. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas. MethodsData collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush cytology slides, H&E-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation. ResultsOur study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging. ConclusionOur study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.

Rapid Immunohistochemistry Based on Ultrasonic Thermal Steam Heating for Improvement of Intraoperative Diagnosis.

To evaluate the role of rapid immunohistochemistry (RIHC) based on ultrasonic thermal steam heating in improving diagnostic accuracy of intraoperative frozen section diagnosis and to recommend RIHC antibody panels for pathologic differential diagnosis. RIHC based on ultrasonic thermal steam heating was tested for intraoperative frozen diagnosis with difficulty in diagnosis, and all slides were reviewed and compared with the final diagnosis. Ninety-three cases of surgical specimens involving RIHC examination were studied. Discordance rates with paraffin immunohistochemistry were calculated. In 93 cases where RIHC was performed, 85 cases (91%) were proven to be helpful for the diagnosis. A total of 58 antibodies were used for RIHC 276 times, of which 19 antibodies were not effective 25 times. Fifteen RIHC antibody panels are recommended based on staining stability and utilization frequency. After improving the staining method, ultrasonic thermal steam heating RIHC is practical, convenient, and cost-effective, making it suitable for use in any pathology department with routine immunohistochemistry reagents. It plays an important auxiliary role in improving the accuracy of intraoperative rapid pathologic diagnosis.

Prognostic study of sentinel lymph node biopsy in early-stage oral squamous cell carcinoma with computed tomography lymphography

PurposeOccult metastasis is a prognostic factor for early-stage oral squamous cell carcinoma (OSCC). Sentinel lymph node (SLN) biopsy (SLNB) is a promising method to detect such metastases. The present study aimed to evaluate the diagnostic reliability of SLNB with computed tomography lymphography (CTL) for early-stage OSCC and to clarify patient outcomes after SLNB. MethodsThe medical records of 42 patients with T1 or T2 cN0 OSCC who had undergone CTL the day before surgery were retrospectively collected and statistically analyzed. ResultsSLNs were identified on CTL in 41 of 42 OSCC patients (97.6 %). Micrometastases were detected in 10 of 41 cases (24.4 %) and 11 of 65 SLNs (16.9 %) by intraoperative pathological diagnosis. Three cases showed occult metastasis within a year after the primary operation. Specificity and negative predictive value were 76.9 % and 90.3 %, respectively. The cumulative 5-year regional recurrence-free rate was 89.7 % in 31 SLNB-negative patients. Five-year overall and disease-free survival rates were 86.9 % and 70.1 %, respectively, in the 41 cases with identified SLNs. ConclusionCTL offers acceptable results and appears likely to be effective in treating early-stage OSCC patients with low-invasive surgery. Further investigation is necessary to compare radioisotope-based methods.

Analysis on features of intraoperative pathological diagnosis of bronchial adenoma by frozen section investigation

Analysis on features of intraoperative pathological diagnosis of bronchial adenoma by frozen section investigation

Development and evaluation of an active motion compensation-based optical imaging system for living tissue

Imaging the surgical margin in vivo at microscopic level can help surgeons make a rapid pathological diagnosis intraoperatively. However, the motion of living tissue induced by respiration or heartbeat remains the critical challenge for the intraoperative microscopic imaging system. In this study, we propose an active motion compensation (AMC) based fluorescence microscopic system to reduce the effect of tissue movement, for which the emitted fluorescent signals are not only to construct the microscopic images, but also to measure the motion of living tissue. To validate the proposed method, an experimental prototype was developed. Then, using this prototype, a series of experiments in vitro and in vivo as well as simulation studies have been conducted for evaluation and validation purposes. In this paper, the proposed AMC-based microscopic imaging system might advance the intraoperative pathological diagnosis technologies.

Touch imprint cytology is useful for the intraoperative pathological diagnosis of PitNETs’ surgical margins

Touch imprint cytology (TIC) and frozen section (FS) procedures are essential for intraoperative pathological diagnosis (IPD). They are invaluable tools for therapeutic decision-making, helping surgeons avoid under or overtreatment of patients. Pituitary neuroendocrine tumors (PitNETs) are generally small, slow-growing tumors with low-grade malignancy located at the base of the skull where it is impossible to maintain a wide tumor margin. Therefore, transsphenoidal surgery (TSS) should be performed with necessary caution, and with sufficient and minimal resection. Thus, this study aimed to evaluate the diagnostic accuracy of TIC for the diagnosis of PitNET and determine its ability to accurately evaluate the surgical margin compared to the FS procedure. A total of 104 fresh specimens from 28 patients who underwent TSS for PitNETs were examined using TIC and FS. TIC specimens were categorized according to the cell imprinting pattern. All specimens with a large number of neuroendocrine cells diffusely attached to the glass surfaces had PitNET components. Contrarily, no rich or diffuse cell attachments were observed in any non-tumoral endocrine cells. In conclusion, recognizing a pattern of endocrine cell adherence to glass is highly effective in IPD to certify the existence of a PitNET component.

NAD(P)H Activated Fluorescent Probe for Rapid Intraoperative Pathological Diagnosis and Tumor Histological Grading

NAD(P)H Activated Fluorescent Probe for Rapid Intraoperative Pathological Diagnosis and Tumor Histological Grading

Usefulness and limitations of intraoperative pathological diagnosis using frozen sections for spinal cord tumors

BackgroundIntraoperative pathological diagnosis has a major influence on the intra- and postoperative management of spinal cord tumors. Thus, the aim of this study was to assess the reliability of intraoperative pathological diagnosis for spinal cord lesions by comparing it with the final pathological diagnosis and to determine its usefulness and limitations. MethodThree-hundred and three consecutive patients (mean age, 53.9 years) with neoplastic spinal cord lesions who underwent initial surgery between 2000 and 2021 were included. The anatomical locations of the spinal cord tumors and the implementation rate of intraoperative pathological diagnosis in each tumor type were evaluated. As the primary outcome, we determined the concordance rates between the intraoperative pathological diagnosis and the final diagnosis. When the intraoperative pathological diagnosis and final diagnosis were the same, the diagnosis was defined as a “match.” Otherwise, the diagnosis was defined as a “mismatch.” ResultsThe overall implementation rate of intraoperative pathological diagnosis was 53%, with implementation rates of 71%, 45%, 47%, and 50% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively. The overall concordance rate was 87.6%, with concordance rates of 80%, 95%, 75%, and 90% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively (p < 0.05). The diagnoses of ependymomas, low-grade astrocytomas, and high-grade astrocytomas was occasionally difficult among intramedullary tumors. Among intradural extramedullary tumors, differentiation between grade 1 meningioma and high-grade meningioma was difficult using intraoperative pathological diagnosis. ConclusionsSurgeons must recognize the lower accuracy of intraoperative pathological diagnosis for intramedullary and extradural lesions and make a final decision by considering the intraoperative gross findings, preoperative clinical course, and imaging.

The Cost Does Not Outweigh the Benefit: Pathologic Evaluation of Wrist Ganglion Cysts Should Not Be Routine.

As health care costs in the United States continue to rise, there is increasing attention on cost-saving measures. One area of investigation is the utility of pathologic examination of specimens from routine procedures with a suspected benign pathology. We assessed the utility and cost of routine pathologic analysis for wrist ganglion cyst excision. A retrospective cohort study of all wrist ganglion cyst excisions performed by seven hand surgeons was conducted from 2015 to 2019 at Penn State Hershey Medical Center. Preoperative and intraoperative diagnoses, pathologic diagnosis, and pathology cost were assessed. A total of 407 patients underwent ganglion cyst excision, with 318 (78.1%) specimens sent for pathologic review. Of the 318, 317 (99.6%) specimens were concordant with the preoperative or intraoperative diagnosis of ganglion cyst. One specimen (0.3%) resulted as a benign cystic vascular malformation. The charge per specimen was $258, totaling $81,786 spent confirming benign pathology that was clinically correctly diagnosed by the operating surgeon in 99.6% of cases. Routine pathologic analysis is not indicated in cases in which surgeons have a high clinical suspicion for ganglion cyst based on preoperative and intraoperative findings. Pathologic review should be reserved for cases with atypical presentations or intraoperative findings.

Diffusely infiltrative squamous cell carcinoma of the esophagus resembling scirrhous gastric cancer: a case report.

The patient was a 75-year-old woman whose chief complaints were dysphagia and upper abdominal pain. Esophagogastroduodenoscopy and biopsy revealed squamous cell carcinoma at the abdominal esophagus. After neoadjuvant chemotherapy, esophagogastroduodenoscopy showed diffuse thickening and poor distensibility of the stomach wall. We suspected scirrhous gastric cancer and performed multiple biopsies, which revealed no evidence of malignancy. We then performed staging laparoscopy. There were no apparent changes in the serous membrane of the stomach, but peritoneal lavage cytology revealed squamous cell carcinoma. Thus, we made a diagnosis of squamous cell carcinoma of the esophagus with diffuse invasion of the stomach. Intraoperative pathological diagnosis revealed that there was greater diffuse submucosal invasion of the oral esophagus than we expected, and we had to resect the esophagus at the level of the middle thoracic esophagus. Despite multidisciplinary treatment (surgery, chemotherapy, and radiotherapy), the patient died 20 months after the initial diagnosis. In this case, although biopsy did not lead to a diagnosis, peritoneal lavage cytology led to the correct diagnosis. Moreover, it was impossible to preoperatively predict the exact extent of the expansion because of diffuse submucosal invasion. When diffusely infiltrative squamous cell carcinoma of the esophagus is suspected, peritoneal lavage cytology may be useful for confirming the diagnosis; however, it should be assumed that accurate preoperative evaluation of the range of diffusely infiltrative squamous cell carcinoma is difficult.

Metabolic characteristics of the various incision margins for breast cancer conservation surgery.

Breast cancer (BC) has recently become the most prevalent malignancy in women. There are many alternative treatments for BC, and for aesthetic and postoperative quality of life concerns, breast-conserving surgery and corresponding adjuvant therapy have become the predominant treatment for early invasive BC. Currently, the main method used to assess the margins for breast-conserving surgery is intraoperative pathological diagnosis. However, the designation of surgical margins is controversial, and metabolomics may be a novel approach to evaluate surgical margins. We collected specimens from 10 breast cancer patients and samples from its surrounding tissues and divided them into cancerous tissue and 1mm, 2mm, 3mm, 5mm and 10mm cutting edge tissues, with a total of 60 samples. The samples were analyzed by mass spectrometry on an ultra-performance liquid chromatography-quadrupole/Orbitrap high resolution platform. The data were then statistically analyzed to detect metabolic changes in the different cutting edges and to identify possible surgical cutting edges with statistically significant findings. Abnormal metabolic pathways were identified by Kyoto Encyclopedia of Genes and Genomes (KEGG), which elucidated potential markers. Statistical analysis indicated that there were substantial differences between the 1mm margin tissue and the cancer tissue, while there were no statistically significant differences between the 1mm tissue and tissues from the other margins. The levels of 6 metabolites in the 1mm tissue were significantly different from those in the cancer tissue and were not significantly different from those in the 2mm tissue. The six metabolites were pyruvate, N-acetyl-L-aspartate, glutamic acid, γ-aminobutyric acid, fumaric acid, and citric acid. Metabolic pathways such as amino acid metabolism and amino t-RNA synthesis in the margin tissue were significantly distinct from those in cancer tissues based on KEGG analysis. There was a significant difference between the 1mm margin tissue and the cancerous tissue. Based on metabolomic analysis, the 1mm negative margin is sufficient for surgery, and the six metabolites that we identified as abnormal, including pyruvic acid, N-acetyl-L-aspartic acid, glutamic acid, gamma-aminobutyric acid, fumaric acid and citric acid, may serve as biomarkers for a negative margin and help surgeons select an appropriate surgical margin.

Rapid, label-free histopathological diagnosis of liver cancer based on Raman spectroscopy and deep learning

Biopsy is the recommended standard for pathological diagnosis of liver carcinoma. However, this method usually requires sectioning and staining, and well-trained pathologists to interpret tissue images. Here, we utilize Raman spectroscopy to study human hepatic tissue samples, developing and validating a workflow for in vitro and intraoperative pathological diagnosis of liver cancer. We distinguish carcinoma tissues from adjacent non-tumour tissues in a rapid, non-disruptive, and label-free manner by using Raman spectroscopy combined with deep learning, which is validated by tissue metabolomics. This technique allows for detailed pathological identification of the cancer tissues, including subtype, differentiation grade, and tumour stage. 2D/3D Raman images of unprocessed human tissue slices with submicrometric resolution are also acquired based on visualization of molecular composition, which could assist in tumour boundary recognition and clinicopathologic diagnosis. Lastly, the potential for a portable handheld Raman system is illustrated during surgery for real-time intraoperative human liver cancer diagnosis.

Intraoperative cytological diagnosis of brain tumours: Apreliminary study using a deep learning model.

Intraoperative pathological diagnosis of central nervous system (CNS) tumours is essential to planning patient management in neuro-oncology. Frozen section slides and cytological preparations provide architectural and cellular information that is analysed by pathologists to reach an intraoperative diagnosis. Progress in the fields of artificial intelligence and machine learning means that AI systems have significant potential for the provision of highly accurate real-time diagnosis in cytopathology. To investigate the efficiency of machine-learning models in the intraoperative cytological diagnosis of CNS tumours. We trained a deep neural network to classify biopsy material for intraoperative tissue diagnosis of four major brain lesions. Overall, 205 medical images were obtained from squash smear slides of histologically correlated cases, with 18 high-grade and 11 low-grade gliomas, 17 metastatic carcinomas, and 9 non-neoplastic pathological brain tissue samples. The neural network model was trained and evaluated using 5-fold cross-validation. The model achieved 95% and 97% diagnostic accuracy in the patch-level classification and patient-level classification tasks, respectively. We conclude that deep learning-based classification of cytological preparations may be a promising complementary method for the rapid and accurate intraoperative diagnosis of CNS tumours.

Application of Intraoperative Rapid Molecular Diagnosis in Precision Surgery for Glioma: Mimic the World Health Organization CNS5 Integrated Diagnosis.

With the advent of the molecular era, the diagnosis and treatment systems of glioma have also changed. A single histological type cannot be used for prognosis grade. Only by combining molecular diagnosis can precision medicine be realized. To develop an automatic integrated gene detection system (AIGS) for intraoperative detection in glioma and to explore its positive role in intraoperative diagnosis and treatment. We analyzed the isocitrate dehydrogenase 1 (IDH1) mutation status of 105 glioma samples and evaluated the product's potential value for diagnosis; 37 glioma samples were detected intraoperatively to evaluate the feasibility of using the product in an actual situation. A blinding method was used to evaluate the effect of the detection technology on the accuracy of intraoperative histopathological diagnosis by pathologists. We also reviewed the current research status in the field of intraoperative molecular diagnosis. Compared with next-generation sequencing, the accuracy of AIGS in detecting IDH1 was 100% for 105 samples and 37 intraoperative samples. The blind diagnostic results were compared between the 2 groups, and the molecular information provided by AIGS increased the intraoperative diagnostic accuracy of glioma by 16.2%. Using the technical advantages of multipoint synchronous detection, we determined the tumor molecular margins for 5 IDH-positive patients and achieved accurate resection at the molecular level. AIGS can quickly and accurately provide molecular information during surgery. This methodology not only improves the accuracy of intraoperative pathological diagnosis but also provides an important molecular basis for determining tumor margins to facilitate precision surgery.

Usefulness of intraoperative rapid immunohistochemistry in the surgical treatment of brain tumors.

In the treatment of primary central nervous system lymphoma (PCNSL), intraoperative rapid pathological diagnosis can dramatically change the surgical strategy, and more accurate diagnostic methods are required. In April 2020, we adopted intraoperative rapid immunohistochemistry (IHC) in addition to conventional rapid intraoperative diagnosis based on morphological assessment, mainly for patients with PCNSL. Here, we investigate the usefulness and significance of intraoperative rapid IHC based on our initial experience. We performed intraoperative rapid IHC using antibodies for cluster of differentiation (CD)20, CD3, leukocyte common antigen (LCA) and glial fibrillary acidic protein (GFAP) using enzyme-labeled antibody methods in 25 patients, including PCNSL patients, from April 2020 to July 2022. We examined the utility of this approach in determining treatment strategies for brain tumors. Postoperative final pathological diagnoses from paraffin-embedded sections were as follows: diffuse large B-cell lymphoma, 16 cases; glioblastoma, six cases; pilocytic astrocytoma, one case; adenocarcinoma, one case; and inflammatory disorder, one case. The entire process took 32 min and staining for CD20, CD3, LCA, and GFAP was comparable to that using paraffin-embedded sections. In all cases, the results of intraoperative rapid IHC were consistent with final pathological diagnoses from paraffin-embedded sections. In addition, in two cases, the results of conventional intraoperative rapid pathological diagnosis based on morphological assessments using frozen sections were drastically changed by adding intraoperative rapid IHC. Intraoperative rapid IHC contributes to deciding appropriate treatment strategies and facilitating early initiation of chemotherapy for PCNSL. This may allow new therapeutic strategies not only for PCNSL but also for other brain tumors.

Endoscopic Extended Transsphenoidal Approach for Sellar and Suprasellar Xanthogranuloma: Potential Implications for Surgical Strategies in Adult Craniopharyngioma

Differentiation of suprasellar xanthogranuloma (XG) from adult craniopharyngioma (CP) can be problematic in endoscopic extended transsphenoidal surgery. We reviewed the clinical data, preoperative imaging, intraoperative endoscopic findings, and intraoperative frozen section pathology in newly diagnosed adult CPs (19 patients) and XGs (6 patients). Intracystic signal intensity was often high on T1-weighted magnetic resonance images in the XGs but low in the CPs (P= 0.015). Capsular intensity was low on T2-weighted imaging in XGs but iso to high in CPs (P < 0.001). Capsular gadolinium enhancement was often seen in CPs and not in XGs (P < 0.001). CPs often had a solid component with contrast enhancement but none in XGs (P < 0.001). Intraoperative endoscopic observations frequently found a whitish solid component in the CPs but yellow to brown fibrous granulomatous lesions in XGs (P < 0.001). The tumor capsule was dark grayish and soft in CPs, whereas it was fibrously hard in XGs (P= 0.002). Yellowish hemosiderin deposits were seen in all XGs (P= 0.003). Intraoperative pathologic diagnosis of CP was all verified whereas no evidence of tumor was found in XGs (P < 0.001). Partial removal was performed in 4 patients with XGs. No recurrence was observed in these patients during the follow-up period (1.5-8 years). Careful interpretation of preoperative magnetic resonance imaging, intraoperative endoscopic findings, and intraoperative frozen section diagnosis may be important for the differential diagnosis between XG and CP. In endoscopic-extended transsphenoidal surgery, intentional partial removal can be effective for XG after careful diagnosis.

The accuracy of pre-operative and intra-operative pathologic diagnosis of complex atypical hyperplasia and endometrial cancer (371)

<b>Objectives:</b> The accuracy of frozen pathology to detect endometrial cancer (EC) among patients with a preoperative diagnosis of complex atypical hyperplasia (CAH) directly influences decisionmaking regarding surgical staging. There is little data exploring what factors influence this accuracy. If there are patient factors that decrease the accuracy of the frozen section, then operative decisionmaking should be altered to accommodate these scenarios. We aimed to assess the accuracy of pre, intra, and postoperative diagnosis among patients with an initial histological diagnosis of CAH. In those patients where the pathologic diagnoses did not match, we investigated any common factors among these patients. <b>Methods:</b> An IRB-approved cohort study of 200 patients was conducted among patients with a diagnosis of CAH who underwent hysterectomy between 2019 to 2020. Information about patient demographics, comorbid conditions, preoperative biopsy, intraoperative frozen biopsy, and final pathology was collected. Matching between biopsy results was noted as a percentage, and only an identical diagnosis was considered a match between evaluations. Comparison of clinical variables between matched and mismatched groups was performed. Numeric variables were compared using the independent 2-sample t-test or Wilcoxon rank-sum test. Categorical variables were compared between the two groups using the Chisquare test or Fisher's exact test. <b>Results:</b> The accuracy of intraoperative frozen compared to postoperative pathology for diagnosis of CAH and EC was 75.8% (95% CI: 0.6283-0.8613). The accuracy of preoperative compared to postoperative pathology for diagnosis of CAH and EC was 72.5% (95% CI: 0.636-0.8025). The prediction accuracy for endometrial cancer between the intraoperative frozen specimen and postoperative pathology was reported as sensitivity, specificity, and positive and negative predictive values of 57.6%, 100%, 100%, and 64.1%, respectively. Among all the patient demographics, comorbid conditions, and surgical factors investigated, there were no statistically significant differences between the rate of matched or unmatched diagnosis between the intraoperative frozen specimen and postoperative pathology. <b>Conclusions:</b> Within our institution, sensitivity, specificity, positive predictive, and negative predictive values were comparable to other studies. Although not statistically significant, there was a higher rate of non-matching intraoperative frozen to final pathologic diagnosis in women with a higher BMI, post-menopausal status, current smokers, preoperative biopsy by dilation and curettage, and prior IUD or DMPA use. This study suggests further exploration of these factors and their influence on the accuracy of frozen pathology analysis.

Application of Surface-Enhanced Raman Spectroscopy in the Screening of Pulmonary Adenocarcinoma Nodules

This study is aimed at evaluating the feasibility of a screening method for the pulmonary adenocarcinoma nodules through surface-enhanced Raman spectroscopy (SERS). Objective. Using SERS to measure serum from pulmonary nodules and healthy subjects, intraoperative biopsy pathological diagnosis was regarded as the gold standard for labeling serum samples. To explore the application value of SERS in the differential diagnosis of pulmonary adenocarcinoma nodules, benign nodules, and healthy, we build a machine learning model. Method. We collected 116 serum samples from patients. Radiographically confirmed nodules less than 3 cm in maximum diameter in all patients, including 58 cancer (pathologic diagnosis: adenocarcinoma nodules, labeled as cancer) patients, 58 pathologic diagnoses as benign nodule (labeled as benign) patients, and 63 healthy (labeled as normal) people from the clinical laboratory of Sichuan Cancer Hospital. Gold nanorods were employed as SERS substrates. Support vector machine (SVM) was used to classify the normal, benign, and cancer sample groups, and SVM model evaluated using cross-validation. Results. The average SERS spectra of serum were significantly different between the normal group and the cancer/benign group. While the average SERS spectra of the cancer group and the benign group differed slightly, for the cancer, benign, and normal groups, SVM models can predict with 93.33% accuracy. Conclusion. This exploratory study demonstrates that the SERS technique based on nanoparticles in conjunction with SVM has great potential as a clinical auxiliary diagnosis and screening for pulmonary adenocarcinoma nodules.

Falciform ligament abscess with disseminated intrahepatic foci: a case report

BackgroundFalciform ligament abscess (FLA) is a rare disease, and its diagnosis can be challenging without typical image findings of an abscess. We report a patient with FLA that presented as a mass, with an indistinct border between it and the liver, in addition to disseminated foci within the liver. This made it difficult to determine whether it was FLA or a malignancy.Case presentationA 69-year-old man presented with epigastric pain. Contrast-enhanced computed tomography revealed a 25-mm mass below the middle of the diaphragm. Based on an initial diagnosis of infection of the falciform ligament, we administered conservative antibiotic treatment and there was initial improvement in the patient’s clinical condition and laboratory data. However, he continued to experience mild epigastric pain. A month later, imaging studies revealed enlargement of the falciform ligament mass and the emergence of a new nodule in the liver, whereas laboratory findings showed re-elevated C-reactive protein levels. Since conservative treatment had failed, we decided to perform surgery. Considering the imaging study findings, malignant disease could not be ruled out. Based on the operative findings, we performed combined resection of the falciform ligament, left liver, and gallbladder. Histopathological examination of the resected specimens revealed extensive neutrophil infiltration and the presence of giant cells and foam cells within the lesions. These findings were indicative of abscess. Pseudomonas aeruginosa was cultured from the pus in the falciform ligament mass and bile in the gallbladder. Although multiple abscesses postoperatively developed in the residual portion of the liver, they could be treated through antibiotic therapy.ConclusionsFLA can spread to both adjacent and distant organs via its rich vascular and lymphatic networks. When FLA displays atypical image findings and/or an atypical clinical course, it can be difficult to distinguish it from malignant disease. In such cases, surgical treatment, with intraoperative pathological diagnosis, should be attempted.