Frozen section examination of liver, gallbladder, and pancreas.
ABSTRACT 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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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 · 2.05 Impact Factor
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ABSTRACT: Intraoperative consultation for the Whipple resection procedure has evolved due to the increasing influence of imaging techniques in surgical planning and decision-making. The indications and utilisation of this service vary, at least to some degree, from one institution to the other. The following discussion is a single institutional approach, which is hoped to provide assistance to the practising pathologists in this field. Special emphasis is given to the relevant anatomical considerations and the most common indications for an intraoperative consultation.Journal of Clinical Pathology 10/2007; 60(9):975-80. DOI:10.1136/jcp.2006.044834 · 2.55 Impact Factor
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ABSTRACT: Gastroenteropancreatic neuroendocrine tumors constitute a heterogeneous group of neoplasms. Surgical resection remains the only curative treatment. Frozen section examination is requested by the surgeon in a large variety of surgical situations, but its use differs greatly according to the location of the tumor and the type of surgery performed. The objective of this review is to describe the main indications for and pitfalls of frozen section examination of gastroenteropancreatic neuroendocrine tumors.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 11/2008; 453(5):441-8. DOI:10.1007/s00428-008-0678-6 · 2.56 Impact Factor