Frozen section examination of pancreas, gallbladder, extrahepatic biliary tree, liver, and gastrointestinal tract
Authors:
Peter Švajdler 1; Ondřej Daum 2,3; Magdaléna Dubová 2,3; Bohuslava Šašková 2,3; Boris Rychlý 4; Marián Švajdler 2,3
Authors‘ workplace:
Oddelenie patológie, Univerzitná nemocnica Louisa Pasteura, Košice, Slovenská Republika
1; Šiklův ústav patologie, Univerzita Karlova v Praze, Lékařská fakulta v Plzni a Fakultní nemocnice Plzeň, Česká republika
2; Bioptická laboratoř, s. r. o., Plzeň, Česká republika
3; Cytopathos, s. r. o., Bratislava
4
Published in:
Čes.-slov. Patol., 54, 2018, No. 2, p. 63-71
Category:
Reviews Article
Overview
The main indications for intraoperative consultation of gastrointestinal tract, liver, and pancreatobiliary system are to evaluate the resection margin and to make a tissue diagnosis of lesions for which preoperative histology is not aviable for various reasons. Special situations include the evaluation of liver donor biopsies for the presence of steatosis and inflamation, or determination that ganglion cells are present in the bowel wall at the level where the anastomosis will be placed in case of Hirschprung’s disease. The most worrisome pitfalls include differentiating pancreatic ductal carcinoma from chronic pancreatitis, distinguishing biliary tree and gallbladder carcinoma from reactive changes caused by inflammation, and recognizing the presence of diffuse adenocarcinoma at the resection margin of the esophagus and stomach.
Keywords:
frozen section – gastrointestinal tract – liver – gallbladder – extrahepatic biliary tree – pancreas
Sources
1. Lechago J. Frozen section examination of liver, gallbladder, and pancreas. Arch Pathol Lab Med 2005; 129(12): 1610-1618.
2. Pai RK, Wilcox R, Noffsinger A, Hart J. Liver, extrahepatic biliary tree, gallbladder, and pancreas. In: Taxy JB, Husain AN, Montag AG, eds. Biopsy interpretation: the frozen section. Philadelphia, PA, Lippincott Williams & Wilkins; 2014: 230–270.
3. Campbell F, Verbeke CS. Pathology of the Pancreas. A practical approach. London, Springer-Verlag; 2013.
4. Ducreux M, Cuhna AS, Caramella C, et al.; ESMO Guidelines Committee. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5: v56-68.
5. Pang TC, Wilson O, Argueta MA, et al. Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility. Pathology 2014; 46(3): 188-192.
6. Kooby DA, Lad NL, Squires MH 3rd, et al. Value of intraoperative neck margin analysis during Whipple for pancreatic adenocarcinoma: a multicenter analysis of 1399 patients. Ann Surg 2014; 260(3): 494-501.
7. Petrucciani N, Nigri G, Debs T, et al. Frozen section analysis of the pancreatic margin during pancreaticoduodenectomy for cancer: Does extending the resection to obtain a secondary R0 provide a survival benefit? Results of a systematic review. Pancreatology 2016; 16(6): 1037-1043.
8. Hermanová M, Lenz J. Diferenciální diagnostika chronické pankreatitidy a duktálního adenokarcinomu pankreatu. Cesk Patol 2012; 48(3): 135-140.
9. Theisen BK, DiCianno R, Singhi AD. Pancreatic frozen section nightmares. Diagn Histopathol 2016; 22(6): 236-242.
10. Hyland C, Kheir SM, Kashlan MB. Frozen section diagnosis of pancreatic carcinoma. A prospective study of 64 cases. Am J Surg Pathol 1981; 5(2): 179–191.
11. Cioc AM, Ellison EC, Proca DM, Lucas JG, Frankel WL. Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med 2002; 126(10): 1169-1173.
12. Sharma S, Green KB. The pancreatic duct and its arteriovenous relationship: an underutilized aid in the diagnosis and distinction of pancreatic adenocarcinoma from pancreatic intraepithelial neoplasia. A study of 126 pancreatectomy specimens. Am J SurgPathol 2004; 28(5): 613-620.
13. Matthaei H, Hong SM, Mayo SC, et al. Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not in fluence outcome in patients with R0 resected pancreatic cancer. Ann Surg Oncol 2011; 18(12): 3493–3499.
14. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17(5): 738-753.
15. Nelson DW, Blanchard TH, Causey MW, Homann JF, Brown TA. Examining the accuracy and clinical usefulness of intraoperative frozen section analysis in the management of pancreatic lesions. Am J Surg 2013; 205(5): 613-617.
16. Doucas H, Neal CP, O‘Reilly K, Dennison AR, Berry DP. Frozen section diagnosis of pancreatic malignancy: a sensitive diagnostic technique. Pancreatology 2006; 6(3): 210-213.
17. Yantiss RK, ed. Frozen section library: Liver, extrahepatic biliary tree and gallbladder. New York, Springer; 2011.
18. You Z, Ma WJ, Deng YL, et al. Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy. Hepatobiliary Pancreat Dis Int 2015; 14(3): 300-304.
19. Endo I, House MG, Klimstra DS, et al. Clinical significance of intraoperative bile duct margin assessment for hilar cholangiocarcinoma. Ann Surg Oncol 2008; 15(8): 2104-2112.
20. Ribero D, Amisano M, Lo Tesoriere R, Rosso S, Ferrero A, Capussotti L. Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma. Ann Surg 2011; 254(5): 776-781.
21. Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005; 103(6): 1210-1216.
22. Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249(2): 296-302.
23. Matthaei H, Lingohr P, Strässer A, et al. Biliary intraepithelial neoplasia (BilIN) is frequently found in surgical margins of biliary tract cancer resection specimens but has no clinical implications. Virchows Arch 2015; 466(2): 133-141.
24. Aoki T, Tsuchida A, Kasuya K, Inoue K, Saito H, Koyanagi Y. Is frozen section effective for diagnosis of unsuspected gallbladder cancer during laparoscopic cholecystectomy? Surg Endosc 2002; 16(1): 197–200.
25. Deng YL, Cheng NS, Zhang SJ, et al. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases. World J Gastroenterol 2015; 21(44): 12653-12659.
26. Furukawa T, Higuchi R, Yamamoto M. Clinical relevance of frozen diagnosis of ductal margins in surgery of bile duct cancer. J Hepatobiliary Pancreat Sci 2014; 21(7): 459-462.
27. Konishi M, Ochiai A, Ojima H, et al. A new histological classification for intra-operative histological examination of the ductal resection margin in cholangiocarcinoma. Cancer Sci 2009; 100(2): 255-260.
28. Yamaguchi K, Chijiiwa K, Saiki S, Shimizu S, Tsuneyoshi M, Tanaka M. Reliability of frozen section diagnosis of gallbladder tumor for detecting carcinoma and depth of its invasion. J Surg Oncol 1997; 65(2): 132–136.
2.9 Okazaki Y, Horimi T, Kotaka M, Morita S, Takasaki M. Study of the intrahepatic surgical margin of hilar bile duct carcinoma. Hepatogastroenterology 2002; 49(45): 625-627.
30. Yamaguchi K, Shirahane K, Nakamura M, et al. Frozen section and permanent diagnoses of the bile duct margin in gallbladder and bile duct cancer. HPB 2005; 7(2): 135-138.
31. Miedema JR, Hunt HV. Practical issues for frozen section diagnosis in gastrointestinal and liver diseases. J Gastrointestin Liver Dis 2010; 19(2): 181-185.
32. Biesterfeld S, Knapp J, Bittinger F, Götte H, Schramm M, Otto G. Frozen section diagnosis in donor liver biopsies: observer variation of semiquantitative and quantitative steatosis assessment. Virchows Arch 2012; 461(2): 177-1783.
33. Jun MJ, Shim JH, Kim SY, et al. Clinical implications of preoperative and intraoperative liver biopsies for evaluating donor steatosis in living related liver transplantation. Liver Transpl 2014; 20(4): 437-445.
34. Jůza T, Jůzová A, Gajdošová T. Kazuistika: Diagnóza až pod mikroskopem - diseminovaná echinokokóza multilokulárního vzhledu s protoskolexy. Cesk Patol 2016; 52(3): 168-172.
35. Honsová E, Lodererová A, Gottfriedová H. Jak v praxi zlepšit bioptickou diagnostiku benigních lézí jater (adenom versus fokální nodulární hyperplazie). Cesk Patol 2013; 49(4): 149-152.
36. Busuttil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver Transpl 2003; 9(7): 651-663.
37. Wang HL, Anderson CD, Glasgow S, et al. Liver. In: Liapis H, Wang HL, eds. Pathology of solid organ transplantation. Springer-Verlag Berlin Heidelberg 2011, 199-314.
38. Rakha E, Ramaiah S, McGregor A. Accuracy of frozen section in the diagnosis of liver mass lesions. J Clin Pathol 2006; 59(4): 352-354.
39. Younes M. Frozen section of the gastrointestinal tract, appendix, and peritoneum. Arch Pathol Lab Med 2005; 129(12): 1558-1564.
40. Chatelain D, Shildknecht H, Trouillet N, Brasseur E, Darrac I, Regimbeau JM. Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections. J Visc Surg 2012; 149(2): e134-142.
41. Panarelli NC, Yantiss RK, eds. Frozen section library: Appendix, colon, and anus. New York, Springer; 2010.
42. Kapur RP. Practical pathology and genetics of Hirschsprung‘s disease. Semin Pediatr Surg 2009; 18(4): 212-223.
43. Squires MH 3rd, Kooby DA, Pawlik TM, et al. Utility of the proximal margin frozen section for resection of gastric adenocarcinoma: a 7-institution study of the US Gastric Cancer Collaborative. Ann Surg Oncol 2014; 21(13): 4202-4210.
44. Shen JG, Cheong JH, Hyung WJ, Kim J, Choi SH, Noh SH. Intraoperative frozen section margin evaluation in gastric cancer of the cardia surgery. Hepatogastroenterology 2006; 53(72): 976-978.
45. Dimoulios P, Koutroubakis IE, Tzardi M, Antoniou P, Matalliotakis IM, Kouroumalis EA. A case of sigmoid endometriosis difficult to differentiate from colon cancer. BMC Gastroenterol 2003; 3: 18.
46. Glimelius B, Tiret E, Cervantes A, Arnold D; ESMO Guidelines Working Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6: vi81-8.
47. Maeda K, Koide Y, Katsuno H. When is local excision appropriate for „early“ rectal cancer? Surg Today 2014; 44(11): 2000-2014.
48. Maia DM. The reliability of frozen-section diagnosis in the pathologic evaluation of Hirschsprung‘s disease. Am J Surg Pathol 2000; 24(12): 1675-1677.
49. Berrebi D, Fouquet V, de Lagausie P, et al. Duhamel operation vs neonatal transanal endorectal pull-through procedure for Hirschsprung disease: which are the changes for pathologists? J Pediatr Surg 2007; 42(4): 688-691.
50. Shayan K, Smith C, Langer JC. Reliability of intraoperative frozen sections in the managementof Hirschsprung‘s disease. J Pediatr Surg 2004; 39(9): 1345-1348.
51. Park SH, Min H, Chi JG, Park KW, Yang HR, Seo JK. Immunohistochemical studies of pediatric intestinal pseudo-obstruction: bcl2, a valuable biomarker to detect immature enteric ganglion cells. Am J Surg Pathol 2005; 29(8): 1017-1024.
52. Agrawal RK, Kakkar N, Vasishta RK, Kumari V, Samujh R, Rao KL. Acetylcholinesterase histochemistry (AChE) -A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease. Diagn Pathol 2015; 10: 208.
53. Burtelow MA, Longacre TA. Utility of microtubule associated protein-2 (MAP-2) immunohistochemistry for identification of ganglion cells in paraffin-embedded rectal suction biopsies. Am J Surg Pathol 2009; 33(7): 1025-1030.
54. White VA, Trotter MJ. Intraoperative consultation/final diagnosis correlation: relationship to tissue type and pathologic process. Arch Pathol Lab Med 2008; 132(1): 29-36.
55. Spicer J, Benay C, Lee L, et al. Diagnostic accuracy and utility of intraoperative microscopic margin analysis of gastric and esophageal adenocarcinoma. Ann Surg Oncol 2014; 21(8): 2580-2586.
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Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
2018 Issue 2
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