title: Utility of intraoperative cytology of resection margins in biliary tract and pancreas tumors.
abstract: BACKGROUND
  Intraoperative diagnosis of resection margins in the biliary tract and pancreas tumors is important in deciding extent of resection; however, diagnosis based solely on frozen sections is sometimes difficult. Therefore, we investigated the usefulness of intraoperative cytology (IC) combined with frozen section (FS) histology. We present the results with a discussion of the value of this combination and its associated problems.
  
  
  METHODS
  We examined 80 bile duct resection margin specimens from 42 patients, and 34 pancreatic resection margin specimens from 29 patients, who underwent intraoperative diagnosis of resection margins during surgery for biliary tract or pancreatic tumors between October 2012 and January 2014. IC was performed on imprint specimens prepared from surfaces of margins being examined. The results were compared with FS and final histology of operative materials.
  
  
  RESULTS
  In IC, excluding cases with insufficient material, the results for bile duct margins; sensitivity was 96.7%, specificity 100% and accuracy 98.7%. The results for pancreatic margins; sensitivity was 100%, specificity 92.9%, and accuracy 93.3%. In FS, the results for bile duct margins; sensitivity was 96.8%, specificity 100%, and accuracy 98.8%. The results for pancreatic margins; sensitivity was 66.7%, specificity 100%, and accuracy 97.1%.
  
  
  CONCLUSIONS
  IC is quick, highly accurate and very easy to perform. This study even included a specimen for which only IC led to an accurate diagnosis. IC used in combination with FS can achieve intraoperative diagnosis with high overall accuracy.
authors.affiliation: Department of Pathology, Hirosaki University Hospital, Hirosaki, Aomori, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Tone
authors.forename: Keiko
authors.initials: K
authors.lastname: Kojima
authors.forename: Keita
authors.initials: K
authors.lastname: Hoshiai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kijima
authors.forename: Akira
authors.initials: A
authors.lastname: Kurose
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D001706:Biopsy; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D018293:Cystadenoma, Serous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: biliary tract tumor; frozen section; intraoperative cytology; pancreas tumor; resection margin