title: Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy.
abstract: BACKGROUND
  Unexpected gallbladder cancer may present with acute cholecystitis-like manifestations. Some authors recommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen section analysis worth advocating?
  
  
  METHODS
  A total of 1162 patients with acute cholecystitis who had undergone simple cholecystectomy in our hospital from February 2009 to February 2014 were enrolled in the study. The data of patients with acute cholecystitis especially those with concurrent gallbladder cancer in terms of clinical characteristics, operative records, frozen section diagnosis and histopathology reports were analyzed.
  
  
  RESULTS
  Thirteen patients with acute cholecystitis were found to have concurrent gallbladder cancer, with an incidence of 1.1% in acute cholecystitis. Forty patients with acute cholecystitis were suspected to have gallbladder cancer by macroscopic examination and specimens were taken for frozen section analysis. Six patients with gallbladder cancer were correctly identified by macroscopic examination alone but 7 patients with gallbladder cancer missed, including 3 patients with advanced cancer (2 T3 and 1 T2). Meanwhile, in 6 gallbladder cancer specimens sent for frozen section analysis, 3 early gallbladder cancers (2 Tis and 1 T1a) were missed by frozen section analysis. However, the remaining 3 patients with advanced gallbladder cancers (2 T3 and 1 T2) were correctly diagnosed.
  
  
  CONCLUSIONS
  The incidence of comorbidity of gallbladder cancer and acute cholecystitis is higher than that of non-acute cholecystitis. The accurate diagnosis of gallbladder cancer by surgeons is poor and frozen section analysis is necessary.
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. nanshengcheng2000@yeah.net.
authors.forename: Zhen
authors.initials: Z
authors.lastname: You
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Ma
authors.forename: Yi-Lei
authors.initials: YL
authors.lastname: Deng
authors.forename: Xian-Ze
authors.initials: XZ
authors.lastname: Xiong
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.forename: Fu-Yu
authors.initials: FY
authors.lastname: Li
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000453:epidemiology / Q000473:pathology*; D002681:China; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D003951:Diagnostic Errors; D005260:Female; D005629:Frozen Sections; D005704:Gallbladder / Q000473:pathology / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests