Abstract：
OBJECTIVE: Hepato-pancreato-biliary (HPB) surgeries are one of the most challenging and complex procedures. Intraoperative frozen section (IFS) diagnosis plays a pivotal role in management decisions. Comprehensive large cohort studies evaluating utility of IFS in HPB malignancies are lacking. This study aimed to evaluate the accuracy of frozen section analysis and to analyse discrepancies and impact of IFS on the surgical decisions.
METHODS: This was a retrospective study of IFS received for the HPB specimens between years 2009 and 2021. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity. Indications, disagreements and impact on the surgical management were analysed.
RESULTS: A total of 1008 specimens were evaluated: bile duct margin (279; 27.7%), gallbladder (203; 20.1%), liver lesions (125 cases; 12.4%), lymph nodes (147; 14.6%), pancreatic margin (120; 11.9%) and deposits (134; 13.3%). IFS were diagnosed as negative for malignancy (805; 79.9%), positive for dysplasia (8; 0.8%), suspicious for malignancy (6; 0.6%) and positive for malignancy (189; 18.8%). The overall diagnostic accuracy was 98.4%, and the discordant rate was 1.6%. The sensitivity, specificity, positive predictive value and negative predictive value were 94.7%, 99.4%, 97.5% and 98.6% respectively. The most important reason of discordant results was technical, followed by interpretational and sampling errors.
CONCLUSIONS: The study demonstrates high diagnostic accuracy (98.4%) of IFS in a large dataset of HPB specimens. This comprehensive analysis apprises of the indications, errors and the impact of IFS diagnosis on subsequent HPB surgical management.
METHODS: This was a retrospective study of IFS received for the HPB specimens between years 2009 and 2021. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity. Indications, disagreements and impact on the surgical management were analysed.
RESULTS: A total of 1008 specimens were evaluated: bile duct margin (279; 27.7%), gallbladder (203; 20.1%), liver lesions (125 cases; 12.4%), lymph nodes (147; 14.6%), pancreatic margin (120; 11.9%) and deposits (134; 13.3%). IFS were diagnosed as negative for malignancy (805; 79.9%), positive for dysplasia (8; 0.8%), suspicious for malignancy (6; 0.6%) and positive for malignancy (189; 18.8%). The overall diagnostic accuracy was 98.4%, and the discordant rate was 1.6%. The sensitivity, specificity, positive predictive value and negative predictive value were 94.7%, 99.4%, 97.5% and 98.6% respectively. The most important reason of discordant results was technical, followed by interpretational and sampling errors.
CONCLUSIONS: The study demonstrates high diagnostic accuracy (98.4%) of IFS in a large dataset of HPB specimens. This comprehensive analysis apprises of the indications, errors and the impact of IFS diagnosis on subsequent HPB surgical management.
摘要：
目的：肝胰胆（HPB）手术是最具挑战性和最复杂的手术之一。术中冰冻切片（IFS）诊断在管理决策中起着举足轻重的作用。缺乏评估IFS在HPB恶性肿瘤中的效用的综合大型队列研究。本研究旨在评估冰冻切片分析的准确性，并分析IFS对手术决策的差异和影响。
方法：这是2009年至2021年HPB标本接受IFS的回顾性研究。将结果与永久性切片进行比较，以评估诊断准确性，敏感性和特异性。指示,分析了分歧和对手术管理的影响。
结果：共评估了1008个标本：胆管边缘（279；27.7％），胆囊（203;20.1%），肝脏病变125例（12.4%），淋巴结（147;14.6%），胰腺边缘（120;11.9％）和沉积物（134;13.3％）。IFS被诊断为恶性肿瘤阴性（805；79.9％），异型增生阳性（8;0.8%），可疑为恶性肿瘤(6;0.6%),恶性肿瘤阳性(189;18.8%)。总体诊断准确率为98.4%,不一致率为1.6%。敏感性,特异性，阳性预测值和阴性预测值分别为94.7%,99.4%,分别为97.5%和98.6%。结果不一致的最重要原因是技术，其次是解释误差和抽样误差。
结论：该研究表明IFS在大型HPB样本数据集中具有很高的诊断准确性（98.4%）。对适应症的全面分析，错误以及IFS诊断对后续HPB手术管理的影响。
方法：这是2009年至2021年HPB标本接受IFS的回顾性研究。将结果与永久性切片进行比较，以评估诊断准确性，敏感性和特异性。指示,分析了分歧和对手术管理的影响。
结果：共评估了1008个标本：胆管边缘（279；27.7％），胆囊（203;20.1%），肝脏病变125例（12.4%），淋巴结（147;14.6%），胰腺边缘（120;11.9％）和沉积物（134;13.3％）。IFS被诊断为恶性肿瘤阴性（805；79.9％），异型增生阳性（8;0.8%），可疑为恶性肿瘤(6;0.6%),恶性肿瘤阳性(189;18.8%)。总体诊断准确率为98.4%,不一致率为1.6%。敏感性,特异性，阳性预测值和阴性预测值分别为94.7%,99.4%,分别为97.5%和98.6%。结果不一致的最重要原因是技术，其次是解释误差和抽样误差。
结论：该研究表明IFS在大型HPB样本数据集中具有很高的诊断准确性（98.4%）。对适应症的全面分析，错误以及IFS诊断对后续HPB手术管理的影响。
