IngentaConnect STRATEGY TO REDUCE THE RISK OF POSITIVE PANCREATIC RESECTION MARG...

Authors: Al-Ghnaniem; Camprodon; Kocher; Portmann; Al-Nawab; Shaikh; Sohail; Patel

Source: ANZ Journal of Surgery, Volume 78, Number 4, April 2008 , pp. 237-239(3)

Abstract:

Background:

The accuracy of histological assessment of frozen section (FS) of the pancreatic resection margin (PRM) at pancreatico-duodenectomy can be improved by concurrent FS examination of a sample of the suspected pancreatic lesion. Methods:

A prospective trial was conducted using archived material. FS of all the PRM and suspected pancreatic lesion of 12 patients randomly selected from a historical group who underwent pancreatico-duodenectomy for suspected malignancy were examined by five histopathologists. They were asked to examine the PRM alone and alongside the suspected lesion. The diagnosis of the PRM was `benign', `malignant' or `defer to paraffin section'. All the histopathologists were blinded to the paraffin section diagnosis. Results:

The main outcome measures were sensitivity, specificity and the incidence of deferring to paraffin section. In this respect examination of the PRM alone had a sensitivity of 70% and a specificity of 87.5%. Concurrent FS examination of PRM with the pancreatic lesion increased the sensitivity to 90% and the specificity to 92.5%. The incidence of deferring to paraffin section was reduced from 17 to 7% (P = 0.03). Conclusion:

This policy is recommended because it improves the diagnostic accuracy of FS evaluation of the PRM resulting in a reduction of residual pancreatic cancer at the pancreatic transection line.

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STRATEGY TO REDUCE THE RISK OF POSITIVE PANCREATIC RESECTION MARGIN AT PANCREATICO-DUODENECTOMY