ObjectiveTo evaluate the predictive value of intraoperative frozen section analysis of the Delphian lymph node (DLN) and pretracheal lymph node (PLN) for central lymph node metastasis (LNM) and recurrence risk stratification in patients with differentiated thyroid carcinoma (DTC). MethodsThis retrospective study included 133 DTC patients who underwent initial surgery with intraoperative frozen section evaluation of the DLN and PLN at the Department of Thyroid and Breast Surgery, Union Hospital, Wuhan, between January 2023 and December 2024. Receiver operating characteristic (ROC) curves were used to assess the predictive value of DLN/PLN metastasis count and ratio for central LNM and recurrence risk stratification. The concordance between intraoperative frozen pathology and final postoperative pathology was also evaluated. ResultsMultivariate analysis identified age (<20 or >50 years) as protective factor (OR=0.332, P=0.012) and capsular invasion as risk factors for DLN/PLN metastasis (OR=2.823, P=0.017). DLN/PLN metastasis number and ratio showed strong predictive performance for central LNM >5 nodes, with AUC of 0.913 [95%CI (0.841, 0.986), P<0.001] and 0.910 [95%CI (0.837, 0.983), P<0.001], and optimal cut-off values of 1.5 nodes and 45.00%, respectively. For predicting intermediate-to-high recurrence risk, AUCs were 0.818 [95%CI (0.740, 0.895), P<0.001] and 0.800 [95%CI (0.720, 0.880), P<0.001], with cut-offs of 0.5 nodes and 26.79%, respectively. Intraoperative frozen pathology demonstrated a sensitivity of 88.00% (66/75), specificity of 100.00% (58/58), positive predictive value of 100.00% (66/66), and negative predictive value of 86.57% (58/67). Concordance with postoperative pathology was high, with a Kappa value of 0.849 [95%CI (0.761, 0.937), P<0.001] and an intraclass correlation coefficient of 0.917 [95%CI (0.885, 0.940), P<0.001]. ConclusionsIntraoperative frozen section analysis of the DLN and PLN demonstrates reliable predictive value for central LNM and recurrence risk stratification in DTC. This method may help identify patients who could benefit from an extended surgical approach and is recommended as a valuable adjunct to intraoperative decision-making.
ObjectiveTo explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. MethodsThe intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. ResultsAccording to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. ConclusionIntraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.
ObjectiveTo understand the current progress of diagnosis and treatment of accidental gallbladder cancer.MethodThe relevant literatures about diagnosis and treatment of accidental gallbladder cancer and gallbladder cancer were analyzed and summarized.ResultsDue to the lack of specific symptoms and signs in most patients with accidental gallbladder cancer at the early stage, appropriate imaging examinations and tumor marker examinations could improve the preoperative diagnosis rate. The radical resection was the most effective method for accidental gallbladder cancer, but there were still some controversies about the scope of resection according to different tumor stages, the choice of laparoscopic cholecystectomy or open cholecystectomy, and the timing of reoperation. The postoperative adjuvant therapy could improve the prognosis of patients, but most patients didn’t receive adjuvant therapy after surgery.ConclusionsMost patients with accidental gallbladder cancer are in the early stage, and most of them could obtain radical resection. If the first operation fails to achieve radical resection or postoperative pathological examination to confirm the diagnosis, comprehensive evaluation of the tumor stage and the patient’s general condition should be performed, and remedial treatment should be taken as soon as possible.