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Published on: November 5, 2019
Frozen section pathology in IPMN: A systematic review
Michael J Kirsch1, Salvador Rodriguez Franco2, Toshitaka Sugawara2
1Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Abstract:
Intraductal papillary mucinous neoplasms (IPMNs) resection margins are assessed intraoperatively using frozen section (IFS) pathology. We conducted a systematic review to evaluate the concordance of IFS with permanent histopathology and the association between IFS margin status and recurrence. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed, Embase, Scopus, and Google Scholar for studies reporting IFS in patients undergoing resection for IPMN. Data, including IFS margin status, recurrence rates, and final pathology, were extracted. Positive margins were defined as high-grade dysplasia or invasive cancer. Seven studies, with a total of 706 patients, met the inclusion criteria. Positive IFS margins were reported in 9.4% of cases, with a high correlation (98%) between IFS and final pathology. Recurrence occurred in 15.4% of patients. Fifty-nine of 85 (69.4%) patients with recurrence of IPMN or intraductal papillary mucinous carcinoma (IPMC) had negative IFS margins. IFS accurately predicts final pathology and is a valuable tool for guiding intraoperative decision-making. A sizeable number of patients experienced recurrence despite negative margins, highlighting the need for adjunct diagnostic modalities and continued surveillance following resection, regardless of margin status.
Insights
Intraductal papillary mucinous neoplasms (IPMNs) frozen section pathology accurately predicts final results. However, recurrence occurs even with negative margins, necessitating ongoing surveillance.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Oncology
Background:
- Intraductal papillary mucinous neoplasms (IPMNs) require precise surgical resection.
- Intraoperative frozen section (IFS) pathology is used to assess resection margins.
- The reliability of IFS for IPMNs and its impact on recurrence are critical.
Purpose of the Study:
- To evaluate the concordance between IFS and permanent histopathology for IPMNs.
- To determine the association between IFS margin status and tumor recurrence.
- To assess the clinical utility of IFS in guiding IPMN resection.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched major databases (PubMed, Embase, Scopus, Google Scholar) for relevant studies.
- Extracted data on IFS margin status, final pathology, and recurrence rates from included studies.
Main Results:
- Seven studies comprising 706 patients met the inclusion criteria.
- A high concordance (98%) was observed between IFS and final pathology.
- Positive IFS margins were identified in 9.4% of cases.
- Tumor recurrence was observed in 15.4% of patients, with a significant proportion having negative IFS margins.
Conclusions:
- Intraoperative frozen section (IFS) pathology demonstrates high accuracy in assessing resection margins for IPMNs.
- IFS is a valuable tool for intraoperative decision-making during IPMN resection.
- Despite negative margins, recurrence is possible, underscoring the need for vigilant post-resection surveillance and potentially adjunct diagnostic methods.
