Diagnostic accuracies of intraoperative frozen section and permanent section examinations for histological grades during
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ORIGINAL ARTICLE
Diagnostic accuracies of intraoperative frozen section and permanent section examinations for histological grades during open biopsy of bone tumors Shinji Miwa1 · Norio Yamamoto1 · Katsuhiro Hayashi1 · Akihiko Takeuchi1 · Kentaro Igarashi1 · Kaoru Tada1 · Takashi Higuchi1 · Hirotaka Yonezawa1 · Sei Morinaga1 · Yoshihiro Araki1 · Yohei Asano1 · Hiroko Ikeda1 · Takayuki Nojima1,2 · Hiroyuki Tsuchiya1 Received: 8 August 2020 / Accepted: 3 November 2020 © Japan Society of Clinical Oncology 2020
Abstract Background A histological diagnosis obtained from an intraoperative frozen section (FS) during biopsy confirms the adequacy of tumor tissue in the specimen. However, some cases show a discrepancy among the intraoperative FS diagnosis, permanent section (PS) diagnosis of the biopsy specimen, and the final diagnosis of the excised tumor specimen. In this study, we retrospectively investigated the diagnostic accuracy of the FS and PS for different types of bone tumors. Methods This study included 377 patients with 411 bone tumors who underwent tumor excision after an open biopsy with intraoperative FS diagnosis. FS, PS, and final diagnoses of the patients were classified into benign tumors/tumor-like lesions, intermediate malignancies, and malignant tumors. To assess diagnostic accuracy, the histological grades in FS and PS diagnoses were compared with those in the final diagnoses. Results The overall diagnostic accuracies of FS and PS were 93% and 97%, respectively. The accuracy of FS and PS for histological grade was 84% and 93% for chondrogenic tumors, 90% and 96% for osteogenic tumors, 97% and 98% for osteoclastic giant cell-rich tumors, 100% and 100% for tumors of undefined neoplastic nature, and 95% and 99% for other bone tumors, respectively. Conclusion These data suggest that surgical planning based on PS diagnosis is recommended for chondrogenic and osteogenic tumors. Keywords Frozen section diagnosis · Accuracy · Histological grade · Bone tumor
Introduction Bone tumors can be treated with surgical excision, radiotherapy, and chemotherapy. The decision regarding the treatment modality is usually based on radiological findings and pathological diagnosis. To obtain the histological diagnosis, needle biopsy is preferred because of their advantages, including convenience, no need for general anesthesia, low contamination risk, and low cost [1–3]. Guidance via * Shinji Miwa [email protected] 1
Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
Department of Pathology, Kanazawa University School of Medicine, Kanazawa, Japan
2
imaging, such as computed tomography (CT) or ultrasonography, during needle biopsies has improved diagnostic accuracies [4, 5]. However, the diagnostic accuracy of needle biopsies is lower than that of open biopsies [1, 6, 7], and needle biopsy yield insufficient amounts of tissue in approximately 5% of patients [8]. Intraoperative frozen section (FS) diagnosis has been commonly performed during biopsies to confirm the
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