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Ten versus five polymorphonuclear leukocytes as threshold in frozen section tests for periprosthetic infection: a
Xiang Zhao1, Chao Guo, Gang-Sheng Zhao
1Department of Orthopedic Surgery, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China.
Abstract:
We objectively appraised available evidence regarding the threshold for the number of polymorphonuclear leukocytes required in frozen section tests used to diagnose periprosthetic infection. Pooled summary estimates for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (OR) were compared for ten and five polymorphonuclear leukocytes per high power field as the threshold. The total cohort included 1011 patients and the rate of infection was 19.2%. Although there was no difference in sensitivity or diagnostic OR, specificity was significantly higher for ten than for five polymorphonuclear leukocytes per high power field (p=0.007) In sum, a threshold of 10 polymorphonuclear leukocytes is better for diagnosing periprosthetic infections.
Insights
A higher threshold of ten polymorphonuclear leukocytes per high power field in frozen section tests improves specificity for diagnosing periprosthetic joint infection compared to five. This finding aids in more accurate infection detection.
Area of Science:
- Orthopedics
- Pathology
- Infectious Diseases
Background:
- Periprosthetic joint infection (PJI) is a severe complication following joint replacement surgery.
- Accurate and timely diagnosis of PJI is crucial for effective treatment and patient outcomes.
- Frozen section analysis of polymorphonuclear leukocytes (PMNs) is a key diagnostic tool.
Purpose of the Study:
- To evaluate the optimal threshold for PMN count in frozen sections for diagnosing PJI.
- To compare the diagnostic performance of 5 vs. 10 PMNs per high power field (HPF).
Main Methods:
- Systematic review and meta-analysis of existing evidence.
- Inclusion of studies reporting PMN counts in frozen sections for PJI diagnosis.
- Pooled analysis of sensitivity, specificity, and diagnostic odds ratio (OR).
Main Results:
- The study included 1011 patients with a 19.2% infection rate.
- No significant difference in sensitivity or diagnostic OR between 5 and 10 PMNs/HPF.
- Specificity was significantly higher for the 10 PMNs/HPF threshold (p=0.007).
Conclusions:
- A threshold of 10 PMNs/HPF demonstrates superior specificity for PJI diagnosis compared to 5 PMNs/HPF.
- This higher threshold may reduce false positives in frozen section analysis for PJI.
- Optimizing PMN thresholds enhances the diagnostic accuracy of frozen sections in PJI evaluation.
