Sensitivity Of Intraoperative Diagnosis Research Articles

Surgical management of the acute paediatric scrotum: a three-year single centre experience.

Acute scrotal pain is a common emergency presentation in paediatric surgery. Torsion of the testicular appendage (TTA) is the most common cause for pain, with testicular torsion (TT) being the sinister pathology to exclude. Outcomes are time dependent, and a delayed scrotal exploration could result in testicular loss. We performed a review on a large retrospective cohort of 449 surgical scrotal explorations at a large referral paediatric surgical centre over three years. Only about a quarter of children with testicular pain presented within 4 h. TT is commonly associated with nausea and an abnormal lie. Two children with a classical 'blue dot' sign were later found to have a testicular torsion. 19% of all children with a TTA were also seen to have Bell clapper anomaly (BCA). Recurrent testicular pain was associated with 84.7% (p < 0.001) of BCA. Intra-operative diagnosis of TTA correlated with histopathology in 84.6% (p=0.021). The sensitivity of intraoperative diagnosis was 90.9% with a specificity of 75.3%. Routine histopathology for a classic TTA may not be required especially in resource poor situations. All children presenting with recurrent episodes of testicular pain must be considered for surgical scrotal exploration. And in view of the incidence of BCA in this cohort, all scrotal explorations for acute scrotal pain should include an assessment for BCA.

Accuracy of Touch Preparation versus Frozen Section for Intraoperative Diagnosis of Sentinel Lymph Node Metastases in Breast Cancer with Emphasis on Micrometastases

The sensitivity of intraoperative diagnosis of sentinel lymph node (SLN) metastases in breast cancer is variably low. The purpose of this study was to review the pros and cons of frozen section (FS) and touch preparation (TP) methods, particularly in micrometastases. Intraoperative TP or FS was performed on the SLN of consecutive breast cancer patients from 2007 to 2009. Sensitivity, specificity, and overall accuracy of detecting positive SLNs were calculated for FS and TP groups. There were 396 patients with SLN biopsy. 124 (31.3 %) patients had at least one positive SLN. A total of 1270 lymph nodes were examined intraoperatively, 133 with FS and 1137 with TP. FS was significantly more sensitive than TP, 82.6% and 49.6%, respectively (p<0.0001). There were a total of 57 SLNs with micrometastases. FS was performed on 10 and TP on 47. The sensitivity of FS was 50% and for TP, 19.3% (p<0.0001). Of the 10 positive SLNs using FS, 3 were negative on permanent sections (PS). We conclude that FS is superior to TP as a method of detecting micrometastases in SLNs. However, a significant subset of patients who had positive SLNs on FS became negative on PS. This raises the possibility that some negative SLNs on FS might have been understaged. [N A J Med Sci. 2012;5(1):13-19.]

The feasibility of intraoperative diagnosis of sentinel lymph node metastases in breast cancer.

The aim of the study was to analyse in detail the feasibility of intraoperative assessment of sentinel lymph nodes in breast cancer. Altogether 139 consecutive breast cancer patients with metastases in axillary sentinel nodes were included in a prospective study. A combination of imprint cytology and frozen section was used as the method of intraoperative diagnosis of sentinel node metastases. The definite postoperative evaluation of the sentinel nodes was taken as the gold standard. The overall sensitivity of intraoperative diagnosis was 83%, reaching 81% if the intraoperative assessment had been limited to the two first retrieved sentinel nodes. False negative (FN) findings were more common in connection with invasive lobular carcinoma (28%) than with invasive ductal carcinoma (8%) (P < 0.01) as well as in connection with micro-metastases, in 38% of the cases, compared to the larger metastases, 6% (P < 0.00005). Intraoperative examination of sentinel lymph nodes enables breast surgery, axillary staging, and treatment in the same operation in a substantial proportion of breast cancer patients. Hospital costs as well as workload in the pathology laboratory may be reduced, limiting the intraoperative assessment to the two first retrieved nodes.