Pancreatic Frozen Section Guides Operative Management With Few Deferrals and Errors

Area of Science:

• Surgical Pathology
• Oncology
• Diagnostic Accuracy

Background:

• Pancreatic adenocarcinoma is a leading cause of cancer mortality in the US.
• Surgery is the primary treatment, with frozen section analysis vital for diagnosis and surgical planning.

Purpose of the Study:

• To assess the utilization and accuracy of frozen section analysis in pancreatic resections.
• To evaluate the impact of frozen section diagnoses on surgical procedures.

Main Methods:

• Retrospective review of 152 patients undergoing pancreatic resection with frozen sections (January 2014-March 2019).
• Analysis of pathology reports, cytology, and operative notes to categorize frozen sections (margins, metastasis, diagnosis, vascular resectability).
• Evaluation of deferral rates, error rates, and surgeon responses to frozen section findings.

Main Results:

• Frozen sections were used in 221 instances across 152 cases, primarily for margin (102) and metastasis (94) assessment.
• Diagnosis deferral occurred in 8.6% of cases (7.2% of sections), and discrepancies/errors were noted in 2.6% of cases (1.8% of sections).
• Surgeons' actions deviated from frozen section diagnosis in 3.6% of sections, often explained by other intraoperative findings.

Conclusions:

• Frozen section analysis is a valuable tool for intraoperative margin and metastasis evaluation during pancreatectomy.
• The procedure demonstrates high diagnostic yield with low deferral and error rates.
• Intraoperative findings frequently clarify discrepancies between frozen section results and subsequent surgical actions.