Intraoperative Frozen Section Evaluation of Pancreatic Specimens and Related Liver Lesions.

Jennifer Vazzano, Wei Chen, Wendy L Frankel
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Abstract

Context.—: Frozen sections are essential in the surgical management of patients, especially those with pancreatic masses, because frozen sections can provide answers intraoperatively and aid in treatment decisions. Pancreas frozen sections are challenging because of the small tissue size, processing artifacts, neoadjuvant treatment effects, and concurrent pancreatitis-like obstructive changes. The authors present a review of intraoperative evaluation of pancreatic specimens.

Objectives.—: To provide an approach to the diagnosis of pancreatic adenocarcinoma on frozen sections and to discuss commonly encountered pitfalls. Indications for pancreas frozen sections and specific margin evaluation will be discussed. We will also review frozen section diagnosis of subcapsular liver lesions and tumors other than metastases of pancreatic ductal adenocarcinoma.

Data sources.—: Data sources included a literature review and the personal experiences of the authors.

Conclusions.—: The features for diagnosis of pancreatic adenocarcinoma include disordered architecture, glands at abnormal locations, and atypical cytology. It is important to be aware of the pitfalls and clues on frozen section. The evaluation of resection margins can be challenging, and in the setting of the resection of cystic tumors, the key is the diagnosis of high-grade dysplasia or cancer. Finally, it is vital to remember the differential diagnosis for subcapsular liver lesions because not all lesions will be metastases of adenocarcinomas or bile duct adenomas. Frozen sections remain a useful tool for the intraoperative management of patients with pancreatic tumors.

胰腺标本及相关肝脏病变的术中冷冻切片评估。
背景:冷冻切片对于手术治疗患者,尤其是胰腺肿块患者至关重要,因为冷冻切片可以在术中提供答案并帮助做出治疗决定。胰腺冷冻切片具有挑战性,因为组织体积小、处理过程中存在伪影、新辅助治疗效果以及并发胰腺炎样梗阻性改变。作者对胰腺标本的术中评估进行了综述:提供通过冰冻切片诊断胰腺腺癌的方法,并讨论常见的误区。将讨论胰腺冰冻切片的适应症和具体的边缘评估。我们还将回顾肝脏囊下病变和胰腺导管腺癌转移以外的肿瘤的冰冻切片诊断:数据来源包括文献综述和作者的个人经验:胰腺腺癌的诊断特征包括结构紊乱、腺体位置异常和细胞学不典型。了解冰冻切片的陷阱和线索非常重要。切除边缘的评估可能具有挑战性,在切除囊性肿瘤的情况下,关键是诊断高级别发育不良或癌症。最后,记住肝囊下病变的鉴别诊断至关重要,因为并非所有病变都是腺癌或胆管腺瘤的转移。冷冻切片仍然是术中处理胰腺肿瘤患者的有用工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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