Residual biliary intraepithelial neoplasia without malignant transformation at resection margin for perihilar cholangiocarcinoma does not require expanded resection: a dual center retrospective study.

BACKGROUND: Additional resection for invasive cancer at perihilar cholangiocarcinoma (pCCA) resection margins has become a consensus. However, controversy still exists regarding whether additional resection is necessary for residual biliary intraepithelial neoplasia (BilIN). METHOD: Consecutive patients with pCCA from two hospitals were enrolled. The incidence and pattern of resection margin BilIN were summarized. Prognosis between patients with negative margins (R0) and BilIN margins were analyzed. Cox regression with a forest plot was used to identify independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS). Subgroup analysis was performed based on BilIN features and tumor characteristics. RESULTS: 306 pCCA patients receiving curative resection were included. 255 had R0 margins and 51 had BilIN margins. There was no significant difference in OS (P = 0.264) or RFS (P = 0.149) between the two group. Specifically, 19 patients with BilIN at distal bile ducts and 32 at proximal bile ducts. 42 patients showed low-grade BilIN, and 9 showed high-grade. Further analysis revealed no significant difference in long-term survival between different locations (P = 0.354), or between different grades (P = 0.772). Portal vein invasion, poor differentiation and lymph node metastasis were considered independent risk factors for OS and RFS, while BilIN was not. Subgroup analysis showed no significant difference in long-term survival between the lymph node metastasis subgroup, or between the portal vein invasion subgroup. CONCLUSION: For pCCA patients underwent curative resection, residual BilIN at resection margin is acceptable. Additional resection is not necessary for such patients to achieve absolute R0 margin.

Unilateral parotid gland Simultaneously primary two different pathological tumors: a case report and literature review / 口腔疾病防治

Objective@#To explore the clinical manifestations, histopathological characteristics, diagnosis, treatment, and prognosis of simultaneous unilateral primary tumors of different pathological types in the parotid gland.@*Methods@#A case of simultaneous unilateral primary parotid gland tumors, i.e., adenolymphoma and basal cell adenoma, was reviewed and analyzed in combination with the literature.@*Results@#The patient discovered a lump in the right parotid gland area one month prior to presentation, and a tumor was palpated in the shallow lobe of the right parotid gland before surgery. According to MR images, the initial diagnoses were tumors of the shallow and deep lobes of the right parotid gland. The tumors of the deep and shallow lobes were excised with part of the gland, and the facial nerves were dissected under general anesthesia. Postoperative pathology revealed an adenolymphoma in the shallow lobe of the right parotid gland and a basal cell adenoma with cystic transformation in the deep lobe. The surgical effect was good, with no complications, and there was no recurrence after 1 year of follow-up. A review of the relevant literature showed that multiple primary tumors of the parotid gland can manifest as the simultaneous presence of two or more types of tumors on both sides or on one side, and the disease is mainly treated with surgery.@*Conclusion@#Multiple unilateral primary parotid gland tumors are rare. Imaging examinations need to be combined with clinical evaluations to prevent missed diagnoses. Surgery is the first treatment option, and patients with benign tumors have a good prognosis.

Value of intraoperative frozen pathological examination in evaluating lymph node involvement in papillary thyroid carcinoma / 肿瘤研究与临床

Objective:To investigate the predictive effect of intraoperative selective lymph node frozen pathological examination on central lymph node metastasis in thyroid papillary carcinoma (PTC).Methods:A total of 721 PTC patients who underwent primary radical thyroidectomy and central lymph node dissection in Xuanwu Hospital of Capital Medical University from January 2015 to June 2019 were selected. All patients underwent intraoperative selective lymph node frozen pathological examination. According to the paraffin section pathological diagnosis results, there were 449 cases of thyroid micropapillary carcinoma (PTMC) and 272 cases of non-PTMC. The association of the frozen pathological examination results of intraoperative prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes with the pathological results of postoperative central lymph nodes was analyzed in all patients and those with central lymph node positive confirmed by postoperative pathological examination in different groups stratified by tumor long diameter, including 192 cases in PTMC group, 142 cases in long diameter >1 cm and <2 cm group and 55 cases in long diameter ≥2 cm group; postoperative paraffin pathological results were treated as the gold standard. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis were calculated.Results:There were 42.8% (192/449) and 72.4% (197/272) of PTMC patients and non-PTMC patients with central lymph node metastasis, respectively. Among 192 PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 28.1% (47/167), 61.4% (70/114) and 53.8% (91/169), respectively based on the intraoperative frozen pathological diagnosis. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 72.4% (139/192) and 27.6% (53/192), respectively. Among 197 non-PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 49.7% (82/165), 51.6% (96/186) and 64.7% (112/173), respectively based on the intraoperative frozen pathological results. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 84.8% (167/197) and 15.2% (30/197), respectively. The sensitivity of intraoperative lymph node frozen pathological results in the diagnosis of central lymph node metastasis for patients with thyroid capsule involvement in PTMC group, long diameter > 1 cm and < 2 cm group and long diameter ≥ 2 cm group was 81.7% (116/142), 81.7% (103/126) and 92.2% (47/51), respectively.Conclusions:Cervical central lymph node metastasis of PTC is common. Intraoperative frozen pathological examination of prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes can effectively predict whether the central lymph nodes are involved, and this hint is more obvious when the tumor long diameter is more than 2 cm and the thyroid capsule is involved.

Factors Influencing the Discordancy Between Intraoperative Frozen Sections and Final Paraffin Pathologies in Ovarian Tumors.

AIM: To retrospectively investigate the pre-operative clinical factors and ultrasonographic features that influence the accuracy of the intraoperative frozen section (IFS) of ovarian tumors. PATIENTS AND METHODS: Women with ovarian tumors that underwent IFS in one tertiary medical center were recruited from January 2010 to December 2018. Demographic and clinical data of these women were retrieved from medical records in the hospital's centralized database. RESULTS: A total of 903 ovarian tumors were enrolled, including 237 (26.2%) benign, 150 (16.6%) borderline tumor, and 516 (57.2%) malignant. The overall accuracy of IFS among all specimens was 89.9%. The sensitivities of IFS in diagnosing borderline tumors (82.0%) and malignant tumors (88.2%) were lower than in diagnosing benign tumors (98.7%, p <0.001, Z-test). The specificity of diagnosing malignant tumors (99.7%) was significantly higher than that of diagnosing benign tumors (94.7%, p <0.001, Z-test). The group with discordant IFS and final paraffin pathology (FPP) had younger age (47.2 ± 14.0 vs. 51.5 ± 11.8 years, p = 0.013, Mann-Whitney U test), and higher percentage of early-stage disease (85.2% vs. 65.1%, p = 0.001, chi-square test) and mucinous (39.3% vs. 3.3%) and endometrioid histologic types (34.4% vs. 20.2%) than the concordant group (all by chi-square test). Menopause (OR 0.34, 95% CI 0.15-0.76, p = 0.009), multicystic tumor in ultrasound (OR 2.14, 95% CI 1.14-4.01, p = 0.018), and ascites existence (OR 0.33, 95% CI 0.14-0.82, p = 0.016) were factors related to the discordant IFS by multivariate analysis. CONCLUSIONS: IFS has good accuracy in the diagnosis of ovarian tumors. We recommend more frozen tissue sampling for sonographic multicystic tumors in premenopausal women to improve the accuracy of IFS.