Frozen sections in gastric cancer: How negative is the false-negative?
Menée à partir de données portant sur 2 002 patients atteints d'un adénocarcinome gastrique ou gastro-œsophagien (âge médian : 65 ans ; 67 % d'hommes), cette étude analyse, du point de vue du taux de faux négatifs, la qualité des contrôles intra-opératoires des marges de résection puis identifie les facteurs associés à une réduction de la précision de ces contrôles
Intraoperative consultation (IOC) on pathologic specimens, or frozen section in common parlance, is a great boon to the operating surgeon. Immediate information can be made available for the surgical team to guide decision making, such as determining whether to embark on further debridement of a potential necrotizing soft-tissue infection, assessing future clinical consequences, and, most commonly, deciding whether to resect additional tissue. It is in this context that the article by McAuliffe et al1 should be read. The authors present a broad analysis of their institutional experience with gastric and gastroesophageal adenocarcinoma during a 23-year period and including a final cohort of 2002 patients in whom IOC by a pathologist was used. They found an overall diagnostic accuracy for IOC of 98.1%, with a false-negative (FN) rate of 1.7%. They also found that signet ring cell and diffuse-type final diagnoses had higher rates of FN results, ranging as high as 4.7% for those who did not undergo neoadjuvant radiotherapy. These findings are representative of the challenges that face cancer surgeons seeking intraoperative pathologic information.
JAMA Surgery , commentaire, 2017