Intraoperative examination (IOE) in pediatric extracranial tumors.
OBJECTIVE
Intraoperative evaluation of surgical specimens by frozen sections (IOE) is required to distinguish benign and malignant lesions, assess surgical margins, and determine sample adequacy of biopsies. In the last years, it has been used also for therapeutic decisions, particularly in children, who may need other ancillary procedures, in case of malignancies. Our purpose was the evaluation of diagnostic accuracy, limits, and different role of IOE in pediatric pathology.


METHODS
From 1990 to 2001, 416 IOEs were performed in 341 children, affected by lymph node pathology, soft tissue tumors, neuroblastic tumors, gonadal germ cell, and stromal tumors, hepatic lesions, renal tumors, and others; the technique was also used to assess surgical margins during major surgeries. IOEs were obtained from Tru-cut biopsies (<1 cm(3)), wide biopsies (>1 cm(3)), or from the whole lesions, and the subsequent final diagnoses were classified as conordant, discordant, and deferred.


RESULTS
Three hundred seventy cases (88.9%) were concordant, 10 (2.4%) discordant, and 36 (8.6%) deferred. The disagreement was found in two small lymph node samples, three soft tissue tumors, one hepatoblastoma, one metastasis, and three surgical margins. The deferred diagnoses were related to lymph node and soft tissue lesions.


CONCLUSIONS
IOE in pediatric oncology may integrate the diagnostic process and supports the therapeutic guidelines of different tumors. In our study, the diagnostic concordance was satisfactory. A rational use of the technique and the awareness of its limits are, however, prerequisites to avoid the risk of overtreatment.
Dall'igna
Patrizia
P
Division of Pediatric Surgery, Department of Pediatrics, University-Hospital of Padua, Padua, Italy. dalligna@pediatria.unipd.it
d'Amore
Emanuele S G
ES
Cecchetto
Giovanni
G
Bisogno
Gianni
G
Carretto
Elena
E
Bitetti
Stefania
S
Famengo
Barbara
B
Alaggio
Rita
R
D002648:Child; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery