Frozen Section Interpretation of Pancreatic Margins

Subspecialized Gastrointestinal Pathologists Versus General Pathologists

Yong Jun Liu, Faye Smith-Chakmakova, Negar Rassaei, Bing Han, Laura M. Enomoto, Henry Crist, Christopher S. Hollenbeak, Dipti Karamchandani

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8% versus 87.5%, 61.1% versus 66.7%, 78.6% versus 41.4%, 95% versus 95.2%, and 93.5% versus 85.1%, respectively. The interobserver agreement between GI and general pathologists was fair ( =.337, P <.001). The interobserver agreement between 2 GI pathologists was fair ( =.373, P =.0005) and between 2 general pathologists was slight ( =.195, P =.042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100%. Our study reaffirms the challenging nature of these FSs.

Original languageEnglish (US)
Pages (from-to)108-115
Number of pages8
JournalInternational Journal of Surgical Pathology
Volume24
Issue number2
DOIs
StatePublished - Apr 1 2016

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Frozen Sections
Pancreatectomy
Adenocarcinoma
Pathologists
Observer Variation
Sensitivity and Specificity
Survival

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

@article{726f7a1c2c0843b6a17666c1022b97f9,
title = "Frozen Section Interpretation of Pancreatic Margins: Subspecialized Gastrointestinal Pathologists Versus General Pathologists",
abstract = "Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8{\%} versus 87.5{\%}, 61.1{\%} versus 66.7{\%}, 78.6{\%} versus 41.4{\%}, 95{\%} versus 95.2{\%}, and 93.5{\%} versus 85.1{\%}, respectively. The interobserver agreement between GI and general pathologists was fair ( =.337, P <.001). The interobserver agreement between 2 GI pathologists was fair ( =.373, P =.0005) and between 2 general pathologists was slight ( =.195, P =.042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100{\%}. Our study reaffirms the challenging nature of these FSs.",
author = "Liu, {Yong Jun} and Faye Smith-Chakmakova and Negar Rassaei and Bing Han and Enomoto, {Laura M.} and Henry Crist and Hollenbeak, {Christopher S.} and Dipti Karamchandani",
year = "2016",
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T1 - Frozen Section Interpretation of Pancreatic Margins

T2 - Subspecialized Gastrointestinal Pathologists Versus General Pathologists

AU - Liu, Yong Jun

AU - Smith-Chakmakova, Faye

AU - Rassaei, Negar

AU - Han, Bing

AU - Enomoto, Laura M.

AU - Crist, Henry

AU - Hollenbeak, Christopher S.

AU - Karamchandani, Dipti

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8% versus 87.5%, 61.1% versus 66.7%, 78.6% versus 41.4%, 95% versus 95.2%, and 93.5% versus 85.1%, respectively. The interobserver agreement between GI and general pathologists was fair ( =.337, P <.001). The interobserver agreement between 2 GI pathologists was fair ( =.373, P =.0005) and between 2 general pathologists was slight ( =.195, P =.042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100%. Our study reaffirms the challenging nature of these FSs.

AB - Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8% versus 87.5%, 61.1% versus 66.7%, 78.6% versus 41.4%, 95% versus 95.2%, and 93.5% versus 85.1%, respectively. The interobserver agreement between GI and general pathologists was fair ( =.337, P <.001). The interobserver agreement between 2 GI pathologists was fair ( =.373, P =.0005) and between 2 general pathologists was slight ( =.195, P =.042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100%. Our study reaffirms the challenging nature of these FSs.

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