Frozen section examination of liver, gallbladder, and pancreas

Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 01/2006; 129(12):1610-8. DOI: 10.1043/1543-2165(2005)129[1610:FSEOLG]2.0.CO;2
Source: PubMed


Frozen section of the liver is a comparatively frequent request that most often applies to a relatively limited number of situations. The only indication for frozen tissue examination of a gallbladder with any frequency is the presence of a polypoid mucosal lesion or a suspicious thickening of the gallbladder wall. A variety of intraoperative consultations may be applicable during surgery of the pancreas.
To examine the indications and pitfalls regarding the gross examination and frozen section performance for liver, gallbladder, and pancreas.
Author experience and review of the pertinent literature.
Although indications are relatively straightforward for frozen section of liver and gallbladder, handling of the pancreas specimens for frozen tissue examination is often a cause for a certain degree of anxiety. This situation is the result of a relative rarity of such specimens outside large tertiary referral medical centers coupled with a variety of confounding factors, including the presence of chronic pancreatitis with distortion of the normal structures and the frequent presence of variable degrees of dysplasia. The suboptimal preservation of the frozen tissue adds further angst to the scenario. In this article, the main issues are critically examined in light of the experience of the author and others.

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    • "Both freezing and sectioning can thus contribute to inferior-quality slides for microscopic examination, which might in turn hinder final diagnosis. Furthermore, if such artifacts occur at the surgical margins, it may not be possible to determine whether the margin is positive or negative for malignancy,[8] which in turn has major implications regarding prognosis and follow-up treatment options. In addition, sectioning also results in significant wastage of tissue, which becomes a major concern for small biopsies that may contain the suspicious lesion in its entirety. "
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    ABSTRACT: Here, we report the first use of a commercial prototype of full-field optical coherence tomography called Light-CT™. Based on the principle of white light interferometry, Light-CT™ generates quick high-resolution three-dimensional tomographic images from unprocessed tissues. Its advantage over the current intra-surgical diagnostic standard, i.e. frozen section analysis, lies in the absence of freezing artifacts, which allows real-time diagnostic impressions, and/or for the tissues to be triaged for subsequent conventional histopathology. In this study, we recapitulate known normal histology in nine formalin fixed ex vivo rat organs (skin, heart, lung, liver, stomach, kidney, prostate, urinary bladder, and testis). Large surface and virtually sectioned stacks of images at varying depths were acquired by a pair of 10×/0.3 numerical aperture water immersion objectives, processed and visualized in real time. Normal histology of the following organs was recapitulated by identifying various tissue microstructures. Skin: epidermis, dermal-epidermal junction and hair follicles with surrounding sebaceous glands in the dermis. Stomach: mucosa with surface pits, submucosa, muscularis propria and serosa. Liver: hepatocytes separated by sinusoidal spaces, central veins and portal triad. Kidney: convoluted tubules, medullary rays (straight tubules) and collecting ducts. Prostate: acini and fibro-muscular stroma. Lung: bronchi, bronchioles, alveolar ducts, alveoli and pleura. Urinary bladder: urothelium, lamina propria, muscularis propria, and serosa. Testis: seminiferous tubules with intra-tubular sperms. Light-CT™ is a powerful imaging tool to perform fast histology on fresh and fixed tissues, without introducing artifacts. Its compact size, ease of handling, fast image acquisition and safe incident light levels makes it well-suited for various intra-operative and intra-procedural triaging and decision making applications.
    06/2011; 2(28):28. DOI:10.4103/2153-3539.82053
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    • "Our literature search shows that the significance of an accurate intraoperative assessment of the uncinate margin and a detailed description of the technique needed to provide this assessment were not documented in the English literature. One particular article provided a thorough description of the IOC for pancreatic surgery, without detailing the technical procedure [14]. Our proposed protocol for the intraoperative assessment of the uncinate margin of PD specimens allows for its accurate evaluation and has not been previously described in the English literature. "
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    ABSTRACT: Currently, there is no consensus regarding the pancreaticoduodenectomy (PD) margins examined intraoperatively or the technical protocol for frozen section examination. The aim of this work was to summarize our experience regarding the intraoperative examination of the uncinate margin and to compare it with the published literature. Our local protocol for the intraoperative assessment of the uncinate margin of the PD specimen is described in this article. A PubMed search limited to English language publications using terms along the theme of pancreaticoduodenectomy and margin was performed. Retrieved articles were categorized according to whether they discussed frozen section margin examination. Ten articles published between 1981 and 2005 were retrieved which discussed the intraoperative examination of PD specimens. Of the 10 articles, 5 discussed the intraoperative consultation for diagnostic purposes only, 2 discussed the consultation for both diagnostic purposes and assessment of margins, and 3 discussed intraoperative assessment of margins only. Of the total of five articles that discussed the intraoperative assessment of margins, none detailed the technical protocol for examining the uncinate margin. Our proposed protocol for the intraoperative assessment of the uncinate margin of PD specimens allows for its accurate evaluation and has not been described previously in the English literature.
    HPB 02/2007; 9(2):146-9. DOI:10.1080/13651820701278273 · 2.68 Impact Factor
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    ABSTRACT: Intraoperative cytopathology is faster, less labor intensive, yields clearer cellular details and can be as accurate as frozen section in the hands of pathologists experienced in the interpretation of cytological preparations. This procedure is particularly valuable for examining small specimens, multiple samples that need to be examined rapidly, and when superior cytological details are required. Nonetheless its use seems to be relatively limited. In this article, we review the general requirements for intraoperative cytology and also detail its value, as well as its limitations and pitfalls.
    Annales de Pathologie 10/2006; 26(5):313-320. DOI:10.1016/S0242-6498(06)70734-9 · 0.29 Impact Factor
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