INTRODUCTION: Differentiating between chronic pancreatitis and pancreatic adenocarcinoma can be difficult due to considerable overlap in disease presentation and radiological signs and the frequent co-existence of the two conditions. In this situation, surgeons may have to proceed to "blind" pancreaticoduodenectomy or attempt to confirm malignancy intraoperatively with frozen section (FS) histology. METHODS: This study attempted to ascertain the false-negative and false-positive rates of undertaking pancreaticoduodenectomies (PD) based on clinical suspicion (CS) or after intraoperative confirmation of malignancy using FS histology. RESULTS: Of patients, 13.6% (nine out of 66) underwent a benign PD in the CS group; 6.7% of patients had a missed malignancy in the FS group (n = 62), but intraoperative histology prevented PD in 35% of patients with benign disease in the FS group. Specificity and sensitivity of intraoperative FS in detecting malignancy was 100% and 89.7%, respectively. Sensitivity of clinical assessment in detecting malignancy was 86.4%. CONCLUSIONS: In experienced hands, intraoperative confirmation of malignancy is effective and will avoid resection in patients with benign disease. However, for many surgeons the chance of missing a small tumour with a false-negative biopsy will be unacceptable and they would prefer to undertake a "blind" resection and accept the mortality risk of pancreaticoduodenectomy for benign disease.
INTRODUCTION: Differentiating between chronic pancreatitis and pancreatic adenocarcinoma can be difficult due to considerable overlap in disease presentation and radiological signs and the frequent co-existence of the two conditions. In this situation, surgeons may have to proceed to "blind" pancreaticoduodenectomy or attempt to confirm malignancy intraoperatively with frozen section (FS) histology. METHODS: This study attempted to ascertain the false-negative and false-positive rates of undertaking pancreaticoduodenectomies (PD) based on clinical suspicion (CS) or after intraoperative confirmation of malignancy using FS histology. RESULTS: Of patients, 13.6% (nine out of 66) underwent a benign PD in the CS group; 6.7% of patients had a missed malignancy in the FS group (n = 62), but intraoperative histology prevented PD in 35% of patients with benign disease in the FS group. Specificity and sensitivity of intraoperative FS in detecting malignancy was 100% and 89.7%, respectively. Sensitivity of clinical assessment in detecting malignancy was 86.4%. CONCLUSIONS: In experienced hands, intraoperative confirmation of malignancy is effective and will avoid resection in patients with benign disease. However, for many surgeons the chance of missing a small tumour with a false-negative biopsy will be unacceptable and they would prefer to undertake a "blind" resection and accept the mortality risk of pancreaticoduodenectomy for benign disease.
Authors: K F D Kuhlmann; D van Poll; S M M de Castro; N T van Heek; O R C Busch; T M van Gulik; H Obertop; D J Gouma Journal: Eur J Surg Oncol Date: 2007-01-09 Impact factor: 4.424
Authors: Christopher D Mann; Sarah C Thomasset; Nicholas A Johnson; Guiseppe Garcea; Christopher P Neal; Ashley R Dennison; David P Berry Journal: ANZ J Surg Date: 2009-06 Impact factor: 1.872
Authors: J J Huang; C J Yeo; T A Sohn; K D Lillemoe; P K Sauter; J Coleman; R H Hruban; J L Cameron Journal: Ann Surg Date: 2000-06 Impact factor: 12.969
Authors: Konstantinos Blouhos; Konstantinos A Boulas; Dimitrios G Tselios; Stavroula P Katsaouni; Basiliki Mauroeidi; Anestis Hatzigeorgiadis Journal: Int J Surg Case Rep Date: 2013-02-24