Abstract
Background
Intraoperative frozen examination is clinically important for negative margin confirmation in cancer surgery. We investigated the diagnostic accuracy of frozen-section assessment and risk factors for positive resection margins by studying gastric cancer specimens from 1115 patients treated at our hospital.
Methods
The results of gastric cancer patients who had undergone intraoperative margin assessment, employing frozen examination, with curative intent in our unit between 2000 and 2017 were retrospectively analyzed. Frozen section assessments were compared with the corresponding permanent section assessments to evaluate the accuracy, sensitivity, and specificity of the former. The causes of discordances between two assessments were examined. In addition, risk factors associated with positive margins were identified.
Results
In total, 1241 specimens were obtained from the 1115 patients. The accuracy, sensitivity, and specificity of frozen-section assessments were 99.4%, 99.5%, and 97.8%, respectively. There were eight discordant cases. Two false-negative cases required another gastrectomy after final pathological diagnosis because of missed neoplastic cells. Six false-positive cases underwent unnecessary additional resection due to false positive results. In our frozen series, 89 cases had a positive margin on permanent section. Multivariate regression analysis of patients with positive surgical margins revealed large diameter (≥ 50 mm) and T4 tumor to be independent risk factors.
Conclusions
Intraoperative frozen examination is a highly accurate method that is useful for achieving negative margins. This procedure is especially recommended for patients with a tumor larger than 50 mm in maximum diameter or serosal invasion to confirm a negative margin.
Similar content being viewed by others
References
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.
Wang SY, Yeh CN, Lee HL, et al. Clinical impact of positive surgical margin status on gastric cancer patients undergoing gastrectomy. Ann Surg Oncol. 2009;16(10):2738–43.
Sun Z, Li DM, Wang ZN, et al. Prognostic significance of microscopic positive margins for gastric cancer patients with potentially curative resection. Ann Surg Oncol. 2009;16(11):3028–37.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.
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):2580–6.
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):976–8.
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):4202–10.
Sobin LH GM, Wittekind C. International Union Against Cancer. TNM Classification of Malignant Tumours. 7th ed. 2009.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edn. Gastric Cancer. 2011;14(2):101–12.
Younes M. Frozen section of the gastrointestinal tract, appendix, and peritoneum. Arch Pathol Lab Med. 2005;129(12):1558–64.
Bickenbach KA, Gonen M, Strong V, Brennan MF, Coit DG. Association of positive transection margins with gastric cancer survival and local recurrence. Ann Surg Oncol. 2013;20(8):2663–8.
Postlewait LM, Maithel SK. The importance of surgical margins in gastric cancer. J Surg Oncol. 2016;113(3):277–82.
Postlewait LM, Squires MH 3rd, Kooby DA, et al. The importance of the proximal resection margin distance for proximal gastric adenocarcinoma: a multi-institutional study of the US Gastric Cancer Collaborative. J Surg Oncol. 2015;112(2):203–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
None of the authors has any conflict of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Nakanishi, K., Morita, S., Taniguchi, H. et al. Diagnostic Accuracy and Usefulness of Intraoperative Margin Assessment by Frozen Section in Gastric Cancer. Ann Surg Oncol 26, 1787–1794 (2019). https://doi.org/10.1245/s10434-019-07302-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-019-07302-1