Frozen section and permanent diagnoses of the bile duct margin in gallbladder and bile duct cancer.
OBJECTIVE
Frozen section diagnosis and permanent diagnosis of bile duct margin predict local recurrence after surgical resection of gallbladder or bile duct carcinoma.


METHODS
Retrospective review.


METHODS
University, tertiary care.


METHODS
A total of 20 patients underwent frozen section diagnosis of bile duct margin for resection of gallbladder and bile duct carcinoma.


RESULTS
Diagnosis of frozen and permanent section of bile duct margin, and local recurrence.


RESULTS
The permanent diagnosis was identical in 15 patients but changed in 5 (from positive to negative in 3 and from negative to positive in 2). The reasons for these changes were overdiagnosis (mucosal lesions in two and mesenchymal components in another) and new recognition of malignant cells on permanent section in the other two. In seven patients with a positive bile duct margin by permanent histology, mucosal spread was evident in two and involvement of the subepithelial layer was present in the other five. No local recurrence occurred in the two patients with epithelial spread and four of the five with subepithelial infiltration.


CONCLUSIONS
Frozen section and permanent diagnoses of the bile duct margin in gallbladder and bile duct carcinoma may be inconsistent in 25% of patients due to overdiagnosis of frozen section or new recognition of cancer cells by permanent histology. In situ carcinoma does not always produce local recurrence, while cancer cells in the subepithelial layer strongly predict occurrence of local recurrence.
Yamaguchi
Koji
K
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. yamaguchi@urgl.med.kyushu-u.ac.jp
Shirahane
Kengo
K
Nakamura
Masafumi
M
Su
Dongming
D
Konomi
Hiroyuki
H
Motoyama
Kentaro
K
Sugitani
Atsushi
A
Mizumoto
Kazuhiro
K
Tanaka
Masao
M