WHIPPLE RESECTION: CONCORDANCE BETWEEN FROZEN SECTION AND PERMANENT SECTION DIAGNOSIS OF SURGICAL MARGINS

Muhammad Bilal, Hina Tariq, Nadira Mamoon

Abstract


Background: Margin assessment is done in Whipple procedures which are usually performed to resect tumours of head of pancreas and ampullary/periampullary region. Aims and objective of the study are to determine the concordance between frozen sections (FS) and permanent sections (PS) of surgical margins in Whipple resections. Methods: It is a retrospective study, from January 2008 to January 2015 (07 years). It includes the specimen with malignancy in final report and for which FS of pancreatic and/or CBD margin(s) were requested. Data was retrieved from Laboratory information system (LIS) database. Results: Of the 41 bile duct margins in cases of ampullary tumours, 03 were positive on FS as well as PS, 35 were negative on FS as well as on PS. Results showed 100% sensitivity, 92.1% specificity, 50% PPV and 100% NPV. Results of 36 pancreatic margins in cases of ampullary showed 100% sensitivity, 97.1% specificity, 50% PPV and 100% NPV. In pancreatic carcinoma cases, none of CBD margins were reported as positive on FS, 02 margins reported as negative were found positive on PS, while 17 were negative on FS as well as PS. Results showed 100% specificity and 89.5% NPV. Of the 27 pancreatic margins tested in pancreatic tumours 100% sensitivity, 94.1% specificity, 88.9% PPV and 100% NPV was found. Conclusion: Factors such as absent prior tissue diagnosis and/or inflammatory processes make margin diagnosis difficult. However, a high concordance was observed between our FS and PS diagnosis.

Keywords: Frozen section; Pancreatic carcinoma; Pancreatic duct

Full Text:

PDF

References


Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg 1987;206(3):358–65.

Khalifa MA. Intraoperative assessment of the Whipple resection specimen. J Clin Pathol 2007;60(9):975–80.

Rosai J, Ackerman LV. Rosai and Ackerman’s surgical pathology. 10th ed. Edingburgh: Elsevier, Mosby; 2011.

Maher E, Ara S, Bishara M, Kurian A, Tauqir S, Ursani N, et al. Intraoperative pathology consultation: error, cause and impact. Can J Surg 2013;56(3):E13–8.

Chang DK, Johns AL, Merrett ND, Gill AJ, Colvin EK, Scarlett CJ, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol 2009;27(17):2855–62.

Pai RK, Wilcox R, Noffsinger A, Hart J. Liver, extrahepatic biliary tree, gallbladder, and pancreas. In: Taxy J, Husain A, Montag A, editors. Biopsy interpretation: the frozen section. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p.256–68.

Cancer Protocol Templates. College of American Pathologists. [Internet]. [cited 2017 Jan 8]. Available from: http://www.cap.org/web/oracle/webcenter/portalapp/pagehierarchy/cancer_protocol_templates.jspx?_adf.ctrl-state=&_afrLoop=97797758839131#!%40%40%3F_afrLoop%3D97797758839131%26_adf.ctrl-state%3D608njie2s_30

Bellizzi MA, Frankel LW. Pancreatic pathology: a practical review. Lab Med 2009;40(7):417–26.

Verbeke CS, Menon KV. Redefining resection margin status in pancreatic cancer. HPB (Oxford) 2009;11(4):282–9.

Holder KN, Yeh IT. Intraoperative evaluation of margin status. Pathol Case Rev 2010;15(5):148–55.

Hyland C, Kheir SM, Kashlan MB. Frozen section diagnosis of pancreatic carcinoma: a prospective study of 64 biopsies. Am J Surg Pathol 1981;5(2):179–91.

Cioc MA, Ellison EC, Proca DM, Lucas JG, Frankel WL. Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med 2002;126(10):1169–73.

Jaafar H. Intraoperative frozen section consultation: concepts, applications and limitations. Malays J Med Sci 2006;13(1):4–12.

Yamaguchi K, Shirahane K, Nakamura M, Su D, Konomi H, Motoyama K, et al. Frozen section and permanent diagnoses of the bile duct margin in gallbladder and bile duct cancer. HPB (Oxford) 2005;7(2):135–8.

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):613–7.

Ahmad Z, Idrees R, Fatima S, Arshad H, Din UN, Memon A, et al. Changes in practice of histopathology and cytopathology in Pakistan. Asian J Cancer Prev 2014;15(9):3829–49.

Porembka MR, Hawkins WG, Linehan DC, Gao F, Ma C, Brunt EM, et al. Radiologic and intraoperative detection of need for mesenteric vein resection in patients with adenocarcinoma of the head of the pancreas. HPB (Oxford) 2011;13(9):633–42.

Badger SA, Brant JL, Jones C, McClements J, Loughbrey MB, Taylor MA, et al. The role of surgery for pancreatic cancer: a 12-year review of patient outcome. Ulster Med J 2010;79(2):70–5.

Kooby DA, Lad NL, Squires MH 3rd, Matihel SK, Sarmiento JM, Staley CA, 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.

Wilson O, Argueta MA, Samra JS, Gill AJ. 19. Frozen section improves the complete excision rates for Whipple’s resection. Pathology (Phila) 2014;46(Suppl 1):S112–3.

Raab SS, Tworek JA, Souers R, Zarbo RJ. The value of monitoring frozen section–permanent section correlation data over time. Arch Pathol Lab Med 2006;130(3):337–42.

White VA, Trotter MJ. Intraoperative consultation/final diagnosis correlation: relationship to tissue typing and pathologic process. Arch Pathol Lab Med 2008;132(1):29–36.

Lad NL, Squires MH, Maithel SK, Fisher SB, Mehta VV, Cardona K, et al. Is it time to stop checking frozen section neck margins during pancreaticoduodenectomy? Ann Surg Oncol 2013;20(11):3626–33.

Mathur A, Ross SB, Luberice K, Kurian T, Vice M, Toomey P, et al. Margin status impacts survival after pancreaticoduodenectomy but negative margins should not be pursued. Am Surg 2014;80(4):353–60.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]